Medical Practice Settings Research Articles

Prostate Specific Antigen (PSA) testing in a general practice 2009-2019.

Prostate-specific antigen (PSA) testing is not recommended as a population screening measure for prostate cancer. PSA testing is nevertheless widespread and is associated with harm due to false-positive test results, overdiagnosis and economic costs. This study sought to document the exposure of patients to PSA testing over a decade in a general medical practice setting. Laboratory results for each year were extracted from the clinical record. A chart review was undertaken for cases of prostate cancer. We report 13,743 PSA results in 3313 men. In any year, 18% of all men and 33% of men aged over 50years had at least one PSA test. Between 4.8 and 21% of first tests exceeded age normal values depending on age. There were 113 incident cancers in the study interval of which 84 (74%) were screen detected. Mortality was lower in screen-detected than symptomatic cancers. Men at our practice are significantly exposed to PSA testing. We found evidence of possible overdiagnosis.

Design and Development of Virtual Reality Application Implementing Age-Friendly Care and the 4Ms: A Quality Improvement Project.

With an increase in the aging population, the application of evidence-based practice in geriatric education can strengthen knowledge, skills, and clinical experience for healthcare students caring for older adults. The Age-Friendly Health System (AFHS) is one of the frameworks founded on providing evidence-based and low-risk care centered on what matters most to older adults, their families, and caregivers. Virtual reality (VR) platforms are gaining popularity due to their ability to provide an immersive, hands-on learning experience resembling an actual medical practice or care setting. Immersive learning enhances students' sensory perceptions, promoting an innovative and engaging way of acquiring concepts that are difficult to teach in real life. This study aimed to design, develop, implement, and evaluate a case-based training module highlighting AFHS and educating medical students on the 4Ms approach in geriatric care (What Matters, Medication, Mentation, and Mobility). The project was a feasibility study completed in two phases. Phase one included planning and developing a case-based scenario incorporating the 4Ms of AFHS. Phase two included implementing and evaluating the VR training module into the geriatric curriculum for medical students. The final VR case displays a hospital and post-acute setting where an elderly patient is admitted for a hip fracture. Students learn how to triage and treat patients from admission to discharge while demonstrating their knowledge of AFHSs. Approximately 10% of students completed the evaluation survey, and preliminary results indicate significant knowledge change in pre-post scenario-based training on an AFHS. The VR education platform and embedded scenario promise an innovative adaptation of technology in learning the concepts of the 4Ms of AFHSs. However, future studies should explore VR education with clinical assessment evaluation to ensure competence in providing age-friendly care.

Management of pain in the inpatient and non-surgical outpatient dermatology settings: A narrative review.

Pain is frequently encountered in dermatology practice, which impairs the activities of daily living, adds to psychological morbidity, and therefore compromises the quality of life. It ranges from mild to severe in intensity across various dermatoses and requires prompt addressal and treatment. Diseases such as extensive pemphigus vulgaris and Stevens-Johnson syndrome are especially painful and require a multidisciplinary approach with the involvement of a pain specialist in their management. The main pathogenic types of pain include visceral nociceptive, somatic nociceptive, and neuropathic types, the latter two being most relevant in dermatological disorders. Somatic nociceptive pain is often seen in patients of Stevens-Johnson syndrome/ Toxic epidermal necrolysis, epidermolysis bullosa, pemphigus vulgaris, erythema nodosum, and hidradenitis suppurativa, while neuropathic pain is part of the disease process in dermatoses like leprosy, herpes zoster, and dysesthesia syndromes. Therapeutic approaches to pain management include the use of non-opioids (acetaminophen, non-steroidal anti-inflammatory agents), opioids, and non-pharmacological therapies, along with appropriate management of the underlying dermatosis. World Health Organisation (WHO) analgesic ladder remains the most commonly employed guideline for the management of pain, although treatment needs individualisation depending on the nature and severity of pain (acute/chronic), type of dermatosis, and patient factors. There is a paucity of literature pertaining to pain management in dermatology and this topic is often neglected due to a lack of awareness and knowledge of the topic. The present review aims to discuss the pain pathway, various painful conditions in the setting of medical dermatology practice, and their management along with relevant pharmacology of the commonly used analgesics.

Distribution of various demographic groups within the Medicare population at different Mohs medical practice settings

Distribution of various demographic groups within the Medicare population at different Mohs medical practice settings

BASE Jumping in the Lauterbrunnen Valley: A Retrospective Cohort Study from 2007 to 2016.

BASE jumping, and especially BASE jumping with the help of wingsuits, is considered one of the most dangerous airborne sports. The valley of Lauterbrunnen in Switzerland has become infamous for the large number of BASE jumps and the high rate of accidents and fatalities. The aim of this study was to evaluate the morbidity and mortality of BASE jumping, to determine the severity of injuries and injury patterns of BASE jumping accidents and to compare preclinical assessment with clinical diagnoses to detect under- or overtriage. This retrospective, descriptive cohort study covers a period of 10 years (2007-2016). The evaluation covered all BASE jumping incidents in the valley of Lauterbrunnen that required either a helicopter mission by the local HEMS (Helicopter Emergency Medical Service) company of Lauterbrunnen, Air Glaciers, or medical care in the regional hospital, the level I trauma centre or the medical practice of the local general practitioner. Besides demographic data, experience in BASE jumping and skydiving as well as BASE jumping technique(s) and details about the rescue missions were collected. The medical data focused on the severity of injuries, as expressed by the National Advisory Committee of Aeronautics (NACA) score in the prehospital assessment as well as the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) retrieved from the clinical records in the hospital or medical practice setting. The patients were predominantly young, experienced male BASE jumpers. Morbidity (injury risk) ranged from 0.05% to 0.2%, and fatality risk from 0.02% to 0.08%. Undertriage was low, with only two cases. Overtriage was significant, with 73.2% of all NACA 4-6 cases not qualifying for major trauma. BASE jumping remains a high-risk sport and is associated with significant rates of injuries and fatalities. Comparison with previous studies indicated that the injury rate may have decreased, but the fatality rate had not. In this known BASE jumping environment, prehospital assessment appears to be good, as we found a low undertriage rate. The high overtriage rate might be an expression of physicians' awareness of high-velocity trauma mechanisms and possible deceleration injuries.

PSAT379 Performance of a Raman Fingerprint in Thyroid Nodules with Indeterminate Cytology: A Prospective Blinded Monocentric Study

Abstract Background Molecular analysis of thyroid fine-needle aspiration biopsy (FNA) was proposed to improve indeterminate nodules management. However, sensibility and specificity as well as the cost of molecular diagnostics require to be improved to increase their cost-effectiveness for medical practice setting. Raman spectroscopy (RS) demonstrated ability in separating benign from malignant thyroid lesions in surgically removed tissues, based on specific RS profile. This study aimed to investigate the diagnostic performance of RS on cytological samples obtained by thyroid FNA. Methods In this prospective, blinded monocentric study, we enrolled 123 patients with indeterminate or worse cytological diagnosis, candidate to surgery according to international guidelines, and submitted to RS analysis of FNA samples. Cytology specimens were evaluated in agreement to Italian Reporting System for Thyroid Cytology1 as follows: TIR1 (non-diagnostic), TIR1C (non-diagnostic-cystic), TIR 2 non-malignant/benign, TIR3A (low-risk indeterminate lesion), TIR3B (high-risk indeterminate lesion), TIR 4 (suspicious of malignancy), or TIR 5 (malignant). As previously published2, the two diagnostic subcategories referred to indeterminate nodules with low (TIR3A) and high risk (TIR3B) of malignancy, may be respectively compared to the class III and Class IV of The Bethesda System for Reporting Thyroid Cytopathology. We compared RS, cytology and final histology, as reference standard, using various statistical approaches. Findings: Our study population included 37 TIR3A, 32 TIR3B, 16 TIR4 and 38 TIR5; the 30.9% of patients had benign histological diagnosis after surgery. In particular, 72.9% of patients classified TIR3A and 31.3% TIR3B had benign histological diagnosis. RS analysis of FNA samples had overall specificity of 86.8% in predicting thyroid malignancy. In indeterminate cytological categories, RS specificity was 86.5%. In patients with TI-RADS score four or five, the specificity of RS increased to 87.5% for TIR3A and reached 100% in TIR3B.; if considering RS positive test, unnecessary surgery was reduced to 7.4% in the whole sample, 33.3% in TIR3A, and 6.7% in TIR 3B. Interpretation: We demonstrated for the first time that RS represents a valuable tool for thyroid cytology and a valid alternative to molecular analyses, able to improve management and reduce unnecessary surgery in indeterminate nodules. Funding: This study was supported by Ministero della Salute, through TIRAMA project (RF-2018-12366568). 1 J Endocrinol Invest. 2014;37(6): 593-599. doi: 10.1007/s40618-014-0062-0 2Cytopathology. 2021;32(6): 714-717. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Interprofessional Collaboration Between a Clinical Pharmacist and Specialty Physicians to Treat Hepatitis C in an Interdisciplinary Medical Practice Setting.

Objective: Describes the activities of a clinical pharmacist in a gastroenterology (GI) clinic providing services to hepatitis C virus (HCV) patients, with a focus on practice management activities and tools. Practice Description: Located inside a GI specialty clinic in Fort Worth, Texas, the pharmacist provides comprehensive medication management under a collaborative practice agreement (CPA). Once referred by the GI physician, the pharmacist has face-to-face patient visits, develops the care plan, orders medications, and follows patients through sustained virologic response and the development of a hepatocellular carcinoma surveillance plan. Practice Innovation: The role of pharmacists in the management of HCV is important to understand. This article details a pharmacist-led clinic in an open GI medical practice. Evaluation: A retrospective chart review study was conducted to assess outcomes related to the integration of the clinical pharmacist. Methods: Completed by the study team, this study included manual chart reviews of patients with the ambulatory care pharmacist-driven HCV practice to pull data and information that were then tabulated using Qualtrics. Results: A total of 95 charts were surveyed, 78 records were created, and 49 patients were started on direct-acting antiviral (DAA) treatment by the pharmacist. Patients required multiple pharmacist communication actions. The minimum duration of the pharmacist service was 6 months and could extend more than 9 months depending on the time it took to get the patient started on medication. Pharmacist integration into the practice resulted in improved intake for the GI clinic, improved interprofessional interaction, and increased utilization of newer treatment modalities for HCV which feature cure rates up to 99% with limited side effects. Conclusion: Clinical pharmacists are well positioned to help navigate patients through the complexities of the medication use system, medication access, drug interactions and adverse effects, promote medication adherence, and allow patients to start and complete therapy.

A medical radar system for non-contact vital sign monitoring and clinical performance evaluation in hospitalized older patients

Medical radar plays an important role in non-contact vital sign monitoring. However, radar is sensitive and susceptible to noise that deteriorates signal quality, making its application unstable in medical practice settings. Previous studies have focused on detecting vital signs from radar output, but mainly used high-quality signals in laboratory settings. Therefore, signal quality evaluation to maintain good-quality signals for processing is crucial for radar applications. This paper presents a vital sign monitoring system using medical radar that automatically evaluates signal quality to eliminate unsatisfactory signals using the support-vector machine and to extract heartbeat and respiration signals using the singular value decomposition method. To evaluate the system performance, we tested it on 10 healthy subjects and compared the obtained vital signs with those measured using a contact-type ECG device and a respiration belt. Two evaluation steps were conducted. First, we measured 10 subjects for evaluating the signal quality in a laboratory setting. The results showed that the accuracy for each subject archive was 93.2%–100%. Second, we extracted vital signs including respiration rate (RR) and the heart rate (HR) following signal quality classification. The results showed RR and HR deviation from 0 to 1 bpm, and 0 to 4 bpm, respectively. Moreover, the system was applied in a real medical practice setting for continuously monitoring the bedside of hospitalized older patients at a hospital.

Влияние детских кисломолочных напитков, обогащенных пребиотиками и пробиотиками, на здоровье ребенка раннего возраста

Nowadays, rational, balanced nutrition and fortified foods are becoming increasingly popular among physicians of different specialties who have medical practice settings throughout the world. Even earlier, these food shave been recommended for the prevention of multiple disorders, including such socially significant diseases as myocardial infarction, diabetes mellitus, obesity, cancer, and allergy. Trends of the past few decades have demonstrated that functional nutrition will provide most benefits if it is started from early childhood. As elsewhere in the world, novel probiotics are regularly developed in Russia as targeted therapies. The use of fermented milk-based products fortified by probiotics like S. Thermophilus FD DVS nutrish® La-5® (Lactobacillus acidophilus), Bifidobacterium animalis subsp. lactis ВВ-12 in baby formulae helps to achieve a balanced diet, develop positive nutritional behavior and to reduce the rate and severity of infectious and allergic diseases in children. The National program for optimizing nutrition of children in the Russian Federation serves as guide for doctors and parents allowing them to select the best products available on the market of commercially produced foods for infants and children. The article provides a definition of functional nutrition and characteristics of fermented foods in children’s diet. It also describes effects of various probiotic strains in the line of functional baby food. KEYWORDS: probiotics, S. Thermophilus, Lactobacillus acidophilus, functional baby food, fermented milk products for complementary feeding, biolact. FOR CITATION: Zakharova I.N., Berezhnaya I.V., Skorobogatova E.V. Fermented milk-based baby drinks fortified by prebiotics and probiotics: impact on the health of infants and young children. Russian Journal of Woman and Child Health. 2022;5(3):253–261 (in Russ.). DOI: 10.32364/2618-8430-2022-5-3-253-261.

Evaluation of patient satisfaction in a Government Homeopathic Hospital in West Bengal, India

Background and aims – Discovering the degree of patient satisfaction in a medical practice setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires.
 Methodology – An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a 5-point Likert scale was used. The questionnaire generated 5 subscales – overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100mm were provided with each single question item and each subscale.
 Results – The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s α were between 0.7-0.9 and test-retest reliability Cohen’s κ was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, P < 0.001; each subscale scores 0.8 < r < 0.9, P < 0.0001, and each question score 0.8 < r < 0.9, P < 0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (P < 0.05, df = 4, 95% CI) establishing discriminant validity.
 Conclusions – Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages.

Unsolicited patient complaints among radiation, medical, and surgical oncologists.

Unsolicited patient complaints (UPCs) about physician practices are nonrandomly associated with malpractice claims and clinical quality. The authors evaluated the distributions and types of UPCs associated with oncologists by specialty and assessed oncologist characteristics associated with UPCs. This retrospective study reviewed UPCs associated with US radiation oncologists (ROs), medical oncologists (MOs), and surgical oncologists (SOs) from 35 health care systems from 2015 to 2018. Average total UPCs were compared by specialty in addition to sex, medical school graduation year, degree, medical school location, residency location, practice setting, and practice region. For continuous variables, linear regression was used to test for an association with total complaints. The study included 1576 physicians: 318 ROs, 1020 MOs, and 238 SOs. The average number of UPCs per physician was different and depended on the oncologic specialty: ROs had significantly fewer complaints (1.28; 95% confidence interval [CI], 1.02-1.54) than MOs (3.81; 95% CI, 3.52-4.10) and SOs (6.89; 95% CI, 5.99-7.79; P < .0001). In a multivariable analysis, oncologic specialty, recency of graduation, and academic practice were predictive of higher total UPCs (P < .05). UPCs described concerns with care and treatment (42.8%), communication (26.4%), accessibility (17.5%), concern for patient (10.3%), and billing (2.9%). ROs had significantly fewer complaints than MOs and SOs and may have a lower risk of malpractice claims as a group. In addition to oncologic specialty, a more recent year of medical school graduation and working at an academic center were independent risk factors for UPCs. Further research is needed to clarify the reasons underlying these associations and to identify interventions that decrease UPCs and associated risks. This study of 1576 oncologists found that radiation oncologists had significantly fewer complaints than medical oncologists, who in turn had significantly fewer complaints than surgical oncologists. Other characteristics associated with more patient complaints included recency of medical school graduation and practice in an academic setting. Oncologists' patient complaints provide information that may have practical applications for patient safety and risk management. Understanding and addressing the characteristics that increase the risk for complaints could improve patients' experiences and outcomes.

Doctors of chiropractic working with or within integrated healthcare delivery systems: a scoping review protocol

IntroductionBack and neck pain are the leading causes of disability worldwide. Doctors of chiropractic (DCs) are trained to manage these common conditions and can provide non-pharmacological treatment aligned with international...

A Quality Improvement Learning Collaborative for Human Papillomavirus Vaccination.

Introduction:Many published accounts have shown that quality improvement (QI) initiatives within medical practice settings can increase vaccination rates. Project ECHO is a telementoring platform that uses video conferencing technology to educate and support healthcare professionals through case-based learning and brief lectures. This manuscript explores the results of a learning collaborative focused on combining QI and Project ECHO to increase human papillomavirus (HPV) vaccination rates within pediatric practices.Methods:The American Academy of Pediatrics (AAP) recruited 3 AAP chapters that then recruited individual pediatricians and their practices for participation. Participants responded to surveys regarding chapter and pediatrician experience and satisfaction. Impact on HPV immunization rates (HPV initiation, series completion, and missed opportunities to vaccinate during visits) was measured using practice reports of chart reviews to AAP’s data aggregator, which produced run charts.Results:Thirty-four pediatricians within 8 practices completed the project; 1 practice withdrew. Physicians self-reported increased confidence in communicating with vaccine-hesitant families and implementing QI activities. We analyzed practice run charts utilizing QI run chart rules and found nonrandom change towards improvement for aggregate missed opportunities to vaccinate but not for HPV vaccine initiation or series completion.Conclusions:An HPV QI learning collaborative improved participant confidence in HPV vaccine communication and QI skills and decreased missed opportunities to vaccinate. Future projects should consider a more extended project period or more frequent data collection to reduce data variability to make it easier to spot nonrandom changes.

Clinically Actionable Findings Derived From Predictive Genomic Testing Offered in a Medical Practice Setting

ObjectiveTo assess the presence of clinically actionable results and other genetic findings in an otherwise healthy population of adults seen in a medical practice setting and offered “predictive” genomic testing. Patients and MethodsIn 2014, a predictive genomics clinic for generally healthy adults was launched through the Mayo Clinic Executive Health Program. Self-identified interested patients met with a genomic nurse and genetic counselor for pretest advice and education. Two genome sequencing platforms and one gene panel–based health screen were offered. Posttest genetic counseling was available for patients who elected testing. From March 1, 2014, through June 1, 2019, 1281 patients were seen and 301 (23.5%) chose testing. Uptake rates increased to 36.3% [70 of 193]) in 2019 from 11.8% [2 of 17] in 2014. Clinically actionable results and genetic findings were analyzed using descriptive statistics. ResultsClinically actionable results were detected in 11.6% of patients (35 of 301), and of those, 51.7% (15 of 29) with a cancer or cardiovascular result = did not have a personal or family history concerning for a hereditary disorder. The most common actionable results were in the BCHE, BRCA2, CHEK2, LDLR, MUTYH, and MYH7 genes. A carrier of at least one recessive condition was found in 53.8% of patients (162 of 301). At least one variant associated with multifactorial disease was found in 44.5% (134 of 301) (eg, 25 patients were heterozygous for the F5 factor V Leiden variant associated with thrombophilia risk). ConclusionOur predictive screening revealed that 11.6% of individuals will test positive for a clinically actionable, likely pathogenic/pathogenic variant. This finding suggests that wider knowledge and adoption of predictive genomic services could be beneficial in medical practice, although additional studies are needed.

Nancy M. Albert, PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM, FHFSA, FAAN

Nancy M. Albert, PhD, CCNS, CHFN, CCRN, NE-BC, FAHA, FCCM, FHFSA, FAAN, is associate chief nursing officer for Cleveland Clinic’s Office of Nursing Research and Innovation, and a clinical nurse specialist in Cleveland Clinic’s Kaufman Center for Heart Failure in the Heart and Vascular Institute, Cleveland, Ohio. Nancy Albert at a young age was interested in art and pictured herself as a potential artist. However, her sister was also skilled in art and pursued it following high school, which encouraged Nancy to look around at other opportunities that might challenge her. She had been exposed to nurses due to childhood illnesses that had required hospitalization and was struck with the work of nurses and her positive interaction with them. As she looked forward to her own career trajectory, Nancy saw nursing as a powerful way of finding meaning and making an important contribution with her life. Following high school, Nancy entered the Huron Road Hospital School of Nursing in East Cleveland Ohio, and has not looked back since. Throughout her academic and practice journey, Nancy has sought opportunities to construct a career pathway that reflected her own sense of creativity and contribution in health care. Her commitment to her own nursing scholarship has been evidenced in advancing her nursing education from diploma nurse to her PhD in Nursing (with a focus on the study of heart failure) from Kent State University. Nancy’s interest in acute care brought her to practice in the intensive care unit and included a range of acute care roles. After being encouraged by a mentor to take her first leadership role of assistant manager on a dialysis unit, Nancy realized that leadership would become a centerpiece that would drive her nursing career forward and would frame her subsequent nursing contributions. After 14 years at Huron Road Hospital, Nancy sought to link her immense curiosity, her interest in research and knowledge generation, and her budding enthusiasm for innovation and the excitement of a research-grounded medical center, and arrived at the Cleveland Clinic as the coronary care nurse manager. Immediately, she felt the synergy of this setting with her own nursing interests in advancing the science and practice of cardiac care and positively impacting the patient experience. This move would serve as the catalyst for her role as a nurse leader. Nancy moved through a number of accelerating nursing leadership roles and eventually accepted a leadership position in a medical practice setting as a manager of outcomes research in heart failure and the manager of the disease management service that would challenge her leadership development and accelerate her commitment and interest in interdisciplinary practice. Also, it would pique her growing interest in innovation and its role in transforming the future of science and practice. Working in the arena of research, clinical trials and clinical studies prepared her for translating her growing knowledge and insights to advancing the science and practice of nursing at the Cleveland Clinic. And it definitively embedded innovation and creativity into her vision of nursing impact and into her own leadership role. The defining innovation moment for Nancy occurred in an innovation retreat at the Cleveland Clinic held by the innovation consulting company, IDEO, opening her to the dynamics associated with creativity and innovation which would inform her leadership practice going forward. She has carried this innovation dynamic into her subsequent leadership roles and has now incorporated innovation into her title and role as associate chief nursing officer for the Cleveland Clinic’s Office of Nursing Research and Innovation.

Health Workforce the Impact of Title VII Physician Workforce Training Programs on Physician’s Practice Location

Research ObjectiveThis study examined the association of HRSA Primary Care Training and Enhancement (PCTE) program and physicians’ practice locations in the United States.Study DesignThis is a cross‐sectional study linking data from HRSA grantee information from 2010 to 2017, the American Medical Association Masterfile 2017, and three federal designations: Health Professional Shortage Areas (HPSAs), Medically Underserved Areas (MUA), and Rural‐Urban Commuting Area code. Data were analyzed using descriptive statistics and multiple logistic regressions to examine the associations between HRSA PCTE funding and physicians’ practice location, adjusting for covariates (age, sex, ownership, school region, primary care physicians, internal medical graduate, patient care, and practice setting).Population StudiedThe physicians who graduated from US medical schools between 2002 and 2017 (N = 364 198).Principal FindingsOverall, among US physicians graduating between 2002 and 2017, 65% graduated from medical schools or training institutions that had received PCTE funding. The majority were male (53%) and worked in hospital settings (40%). Among PCTE funded schools or training institutions, physicians graduating between 2010 and 2017 were more likely to practice in HPSA areas compared to those who graduated between 2002 and 2009 (respectively 18.6% vs 17.4%, P &lt; .001). In contrast, physicians graduating between 2010 and 2017 were less likely to practice in MUA areas compared to those who graduated between 2002 and 2009 (respectively 6.4% vs 7.7%, P &lt; .001). Around 4% of physicians practiced in rural areas, and there was no difference between the two‐time periods. After adjusting for covariates, physicians graduating after 2010 from schools/training institutions with PCTE funding were more likely to practice in rural areas (Odds Ratio [95%CI]: 1.25[1.16‐1.35]). The same pattern was found for those practicing in HPSAs, but it was not statistically significant (1.01[0.98‐1.04]). In terms of practicing in MUAs, physicians who graduated from schools/training institutions receiving PCTE funding were less likely to practice in MUA, but it was not statistically significant (0.96[0.91‐1.02]). Additionally, the study found that physicians who graduated from schools/training institutions receiving funding for physician faculty development in primary care and physician assistant training in primary care were less likely to practice in HPSAs (respectively 0.94[0.89‐0.99], 0.90[0.85‐0.96]).ConclusionsHRSA training program funding has a positive impact on physicians’ location choice. HRSA‐funded schools/ training institutions produced a greater percentage of physicians practicing in rural areas and low‐income communities than those without HRSA‐funded programs, thus improving access to, and the delivery of, healthcare services to underserved populations.Implications for Policy or PracticeOur study provides preliminary evidence that physicians graduating from schools/training programs receiving HRSA training funding have an increased likelihood of practicing in rural areas. HRSA’s Title VII Primary Care Training and Enhancement (PCTE) program funding is associated with physicians’ chosen practice locations. However, future studies are needed to understand the mechanism of the effect of training program on physicians' practice location choices.

The risk of low risk: First time motherhood, prematurity and dyadic well-being.

Premature birth has a well-documented impact on infants, mothers and their dyadic interactions. First time motherhood in the context of low risk premature birth-relatively unexplored in the literature-is a specific experience that sits at the nexus of premature infancy, motherhood and the processes that underpin dyadic connection. This qualitative study analyzed semistructured interviews with first time mothers of low risk premature babies. Findings were generated in response to research questions concerning mothers' meaning-making, bonding and identity. Findings demonstrated that maternal meaning-making emerged from a dyadic framework. When mothers or their infants were considered outside of a dyadic context, surplus suffering inadvertently occurred. Findings have important implications for infant mental health practice in medical settings, for postnatal support in the aftermath of premature birth, and for understanding the meaning of risk.

Culinary Medicine Basics and Applications in Medical Education in the United States.

Culinary medicine is an evidence-based field of medicine that combines nutrition science and culinary arts to create food that is delicious, promotes wellness, prevents and treats disease. Historically, nutrition education has been limited to fewer than 20 hours in the preclinical years of undergraduate medical education, focused on nutrients rather than food, and largely separated from the clinical experience. Programs at all levels of medical training are introducing culinary medicine educational opportunities to bridge this gap in practical nutrition knowledge and skills to better prepare physicians to help their patients make healthy dietary changes. These courses have an added benefit of helping physicians improve their own diets, which may improve personal health and help them to prevent burnout. Culinary medicine courses are diverse in their organization, class duration and number, format, type of instructor(s), location, and dietary strategy employed. This flexibility means that nearly any medical practice or educational setting can provide some amount of culinary medicine content if institutional support exists. Given the increasing prevalence of diet-related diseases, demand for culinary medicine courses will likely continue to grow.

Facilitating Education on Sugar-Sweetened Beverages in Medical and Dental Care Practice Settings

Facilitating Education on Sugar-Sweetened Beverages in Medical and Dental Care Practice Settings

Radial shockwave therapy for male erectile rejuvenation in a dermatology and/or medical aesthetic practice.

Erectile dysfunction is defined as the inability to achieve and maintain an erection to satisfactorily complete intercourse. Treatment depends on the cause and includes phosphodiesterase 5 inhibitor medications, penile pumps, implants, and surgery. Low-intensity shockwave therapy has been shown to be effective and safe for the treatment of erectile dysfunction. We explored the role of low-intensity radial shockwave therapy for erectile dysfunction treatment in a dermatology and/or medical aesthetic practice setting. A literature review was conducted on radial low-intensity shockwave technology in use for erectile rejuvenation to explore its positioning, safety, efficacy, tolerability, subject satisfaction, and usability in a dermatology and/or medical aesthetic setting. Low-intensity shockwave therapy was shown to be effective in subjects with organic erectile dysfunction, and the treatment effect was maintained for up to 2years post-treatment. The treatment is reported to be safe and well-tolerated and have little downtime. Many dermatologists use low-intensity shockwave therapy for the treatment of cellulite and other conditions. This type of treatment is now available for erectile dysfunction and seems an attractive and safe option for subjects with organic vascular erectile dysfunction. Studies and clinical experience suggest that male erectile rejuvenation using low-intensity radial shockwave therapy seems an attractive option. The treatment can be safely, and effectively, delivered by trained staff as part of the total package that is available to men in a dermatology and/or medical aesthetic practice.