Antimicrobial Resistance
Antimicrobial resistance (AR) is one of the most serious public health threats today, which has been accelerated by the overuse and misuse of antimicrobials in humans and animals plus inadequate infection prevention. Numerous studies have shown a relationship between antimicrobial use and resistance. Antimicrobial stewardship (AS) programs have been shown to improve patient outcomes, reduce antimicrobial adverse events, and decrease AR. AS programs, when implemented alongside infection control measures, especially hand-hygiene interventions, were more effective than implementation of AS alone. Targeted coordination and pre...
Source: Medical Clinics of North America - June 26, 2018 Category: Primary Care Authors: Edward Joel Septimus Source Type: research

Nontraditional Alcohol and Opioid Agonist Treatment Interventions
This article reviews the available evidence of these treatment modalities. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - June 20, 2018 Category: Primary Care Authors: Christopher Fairgrieve, Nadia Fairbairn, Jeffrey H. Samet, Seonaid Nolan Source Type: research

Office-Based Addiction Treatment in Primary Care
Primary care is an important setting for delivering evidence-based treatment to address substance use disorders. To date, effective approaches to treat, care largely incorporate pharmacotherapy with counseling-based interventions and rely on multidisciplinary teams. There is strong support for primary care-based approaches to address alcohol and opioid use disorder with growing data focused on people living with human immunodeficiency virus and those experiencing incarceration. Future work should focus on the implementation of these effective approaches to decrease health disparities among people with substance use and to ...
Source: Medical Clinics of North America - June 20, 2018 Category: Primary Care Authors: E. Jennifer Edelman, Benjamin J. Oldfield, Jeanette M. Tetrault Source Type: research

When and How to Treat Possible Cannabis Use Disorder
This article reviews the current state of knowledge regarding effective treatments for cannabis use disorder. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - June 20, 2018 Category: Primary Care Authors: Annie L évesque, Bernard Le Foll Source Type: research

New and Emerging Illicit Psychoactive Substances
Several novel psychoactive substances have emerged in recent years. Users are typically young men who use other substances. In the category of stimulants, cathinones ( “bath salts”) have predominated and can lead to agitation, psychosis, hyperthermia, and death. Synthetic cannabinoids (“spice”) are more potent than marijuana and can lead to agitation, psychosis, seizures, and death. There are no rapid tests to identify these substances and general treatmen t includes benzodiazepines for agitation and supportive therapy. Many Synthetic opioids are potent analogues of fentanyl and carry a high risk of...
Source: Medical Clinics of North America - June 20, 2018 Category: Primary Care Authors: Ryan Graddy, Megan E. Buresh, Darius A. Rastegar Source Type: research

Pain and Addiction
The current opioid crisis highlights an urgent need for better paradigms for prevention and treatment of chronic pain and addiction. Although many approach this complex clinical condition with the question, “Is this pain or is this addiction?,” it is more than the sum of its parts. Chronic pain among those with dependence and addiction often evolves into a complex disabling condition with pain at multiple sites, psychosocial dysfunctions, medical and psychiatric disorders, polypharmacy, and polysub stance use, all interacting with each other in complex ways (multimorbidity). The authors offer an integrative the...
Source: Medical Clinics of North America - June 20, 2018 Category: Primary Care Authors: Ajay Manhapra, William C. Becker Source Type: research

Addressing Adolescents ’ and Young Adults’ Substance Use Disorders
Adolescents and young adults (AYAs) have unique needs and important biopsychosocial differences when compared with older adults who use substances. As their brains continue to develop, youth are especially susceptible to the reinforcing effects of substances in the context of a still-developing capacity for executive control and decision making. In this article, the authors highlight key differences in the neurobiologic, epidemiologic, and relational aspects of substance use found in AYA. They also discuss how best to engage with youth who use substances and how prevention and intervention can be adapted for optimal effect...
Source: Medical Clinics of North America - June 20, 2018 Category: Primary Care Authors: Nicholas Chadi, Sarah M. Bagley, Scott E. Hadland Source Type: research

Inpatient Addiction Consult Service
Substance use disorders are highly prevalent and are a large driver of costly inpatient medical care; however, historically the substance use disorder has gone unaddressed during an inpatient stay. Inpatient addiction consult services are an important intervention to use the reachable moment of hospitalization to engage patients and initiate addiction treatment. Addiction consultation involves taking an addiction-specific history, motivational interviewing, withdrawal symptom management, and initiation of long-term pharmacotherapy. Addiction consult services have the potential to decrease readmissions and utilization costs...
Source: Medical Clinics of North America - June 20, 2018 Category: Primary Care Authors: Zoe M. Weinstein, Sarah E. Wakeman, Seonaid Nolan Source Type: research

Weighing the Risks and Benefits of Electronic Cigarette Use in High-Risk Populations
This article reviews the current evidence on electronic cigarette (e-cigarette) safety and efficacy for smoking cessation, with a focus on smokers with cardiovascular disease, pulmonary disease, or serious mental illness. In the United States, adult smokers use e-cigarettes primarily to quit or reduce cigarette smoking. An understanding of the potential risks and benefits of e-cigarette use may help clinicians counsel smokers about the potential impact of e-cigarettes on health. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - June 20, 2018 Category: Primary Care Authors: Deepa R. Camenga, Hilary A. Tindle Source Type: research

The Internist ’s Challenge: Addressing Our Patients’ Unhealthy Substance Use
The first two decades of the twenty-first century will be remembered as the time when the harm of illicit drug use, longstanding cause of substantial morbidity and mortality, gained the undivided attention of North Americans due to a devastating opioid crisis. Remarkably, the adverse consequences of opioids and other drugs are an almost-daily feature in the media as deaths from overdoses mount. At the same time, legal substances, alcohol and tobacco, continue to quietly but dreadfully leave even greater overall health consequences in their wake. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - June 20, 2018 Category: Primary Care Authors: Jeffrey H. Samet, Patrick G. O'Connor, Michael D. Stein Tags: Preface Source Type: research

CME Accreditation page
(Source: Medical Clinics of North America)
Source: Medical Clinics of North America - June 20, 2018 Category: Primary Care Source Type: research

Substance Use and Addiction Medicine
MEDICAL CLINICS OF NORTH AMERICA (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - June 20, 2018 Category: Primary Care Authors: Jeffrey H. Samet, Patrick G. O'Connor, Michael D. Stein Source Type: research

Copyright
ELSEVIER (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - June 20, 2018 Category: Primary Care Source Type: research

Forthcoming Issues
Antimicrobial Stewardship (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - June 20, 2018 Category: Primary Care Source Type: research

Contributors
BIMAL H. ASHAR, MD, MBA, FACP (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - June 20, 2018 Category: Primary Care Source Type: research

Contents
Bimal H. Ashar (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - June 20, 2018 Category: Primary Care Source Type: research

Antimicrobial Stewardship Programs
Antimicrobial stewardship involves optimizing antibiotic use while using cost-effective interventions to minimize antibiotic resistance and control Clostridium difficile. An effective hospital-wide antimicrobial stewardship program (ASP) should be led by an infectious disease (ID) physician. The ASP team needs full and ongoing financial support for the ASP from the hospital administration. The ID clinician leader should have special expertise in various aspects of antimicrobial therapy, that is, pharmacokinetics, resistance, pharmacoeconomics, and C difficile. The ASP ID team leader and ID-trained clinical pharmacist staff...
Source: Medical Clinics of North America - June 14, 2018 Category: Primary Care Authors: Cheston B. Cunha Source Type: research

Antibiotic Stewardship Program Perspective
Traditionally, initial antibiotic therapy was administered intravenously (IV). Over the past 3 decades, there has been increased understanding, appreciation, and application of pharmacokinetic (PK) and pharmacodynamic (PD) principles in antibiotic therapy. The utilization of PK/PD parameters as applied to antimicrobial therapy has led to optimizing dosage regimens as well as increased awareness and experience with oral versus antibiotic therapy. When an oral antibiotic, given at the same dose as its IV formulation, results in the same serum/tissue levels, then oral antibiotics should be used whenever possible. When chosen ...
Source: Medical Clinics of North America - June 14, 2018 Category: Primary Care Authors: Cheston B. Cunha Source Type: research

Addressing Unhealthy Substance Use in Primary Care
Unhealthy substance use is common in primary care populations and is a major contributor to morbidity and mortality. Two key strategies to address unhealthy substance use in primary care are the process of screening, brief intervention, and referral to treatment (SBIRT), and integration of treatment for substance use disorders into primary care. Implementation of SBIRT requires buy-in from practice leaders, careful planning, and staff and primary care provider training. Primary care –based treatment of opioid and alcohol use disorders can be effective; more data are needed to better understand the benefits of these m...
Source: Medical Clinics of North America - May 15, 2018 Category: Primary Care Authors: Christine A. Pace, Lisa A. Uebelacker Source Type: research

Preventing Opioid Overdose in the Clinic and Hospital
Drawing from existing opioid prescribing guidelines, this article describes how medical providers can reduce the risk of overdose. Through primary prevention, providers can prevent initial exposure and associated risks by educating patients, using risk stratification, minimizing opioid dose and duration, and avoiding coprescribing with sedatives. Secondary prevention efforts include monitoring patients with urine toxicology and prescription monitoring programs, and screening for opioid use disorders. Tertiary prevention includes treating opioid use disorders and providing naloxone to prevent overdose death. Specific preven...
Source: Medical Clinics of North America - May 15, 2018 Category: Primary Care Authors: Stephanie Lee Peglow, Ingrid A. Binswanger Source Type: research

The Role of Technology-Based Interventions for Substance Use Disorders in Primary Care
This article provides an overview of technology-based interventions (eg, computer-based and Web-based interventions, text messaging, interactive voice recognition, smartphone apps, and emerging technologies) that are extending the reach of effective addiction treatments both in substance use treatment and primary care settings. It discusses the efficacy of existing technology-based interventions for SUDs, prospects for emerging technologies, and special considerations when integrating technologies in primary care (eg, privacy and regulatory protocols) to enhance the management of SUDs. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - May 15, 2018 Category: Primary Care Authors: Babak Tofighi, Ana Abrantes, Michael Stein Source Type: research

Sleep Management Among Patients with Substance Use Disorders
Sleep and substance use disorders commonly co-occur. Insomnia is commonly associated with use and withdrawal from substances. Circadian rhythm abnormalities are being increasingly linked with psychoactive substance use. Other sleep disorders, such as sleep-related breathing disorder, should be considered in the differential diagnosis of insomnia, especially in those with opioid use or alcohol use disorder. Insomnia that is brief or occurs in the context of active substance use is best treated by promoting abstinence. A referral to a sleep medicine clinic should be considered for those with chronic insomnia or when another ...
Source: Medical Clinics of North America - May 15, 2018 Category: Primary Care Authors: Subhajit Chakravorty, Ryan G. Vandrey, Sean He, Michael D. Stein Source Type: research

Smoking Cessation for Those Pursuing Recovery from Substance Use Disorders
This article summarizes the literature regarding the similar biopsychosocial mechanisms of tobacco use and alcohol and substance use disorders, and the evidence for and against the provision of tobacco cessation for those in treatment for alcohol and substance use disorders. The practicality of treatment, focusing on methods, timing, and breadth of intervention strategies, are also presented. Common methodologies that may be used across tobacco use and alcohol and substance use disorder to prevent lapse and relapse are discussed. Physicians can and should adhere to the policy that tobacco use is a common and dangerous como...
Source: Medical Clinics of North America - May 15, 2018 Category: Primary Care Authors: Karen J. Derefinko, Francisco I. Salgado Garc ía, Daniel D. Sumrok Source Type: research

More than “Just Say No”
In 2001, the Joint Commission on the Accreditation of Healthcare Organizations issued standards for hospitals designed to draw attention to the underassessment and undertreatment of pain. Many organizations reacted by adopting the “5th vital sign” of pain assessment. The Wong-Baker FACES Pain Rating scale was used widely by practices to identify the pain status in all patients. Narcotic prescriptions, which had already been rising, increased even further as providers were “educated” by pharmaceutical companies as to t he safety of opioids. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - May 4, 2018 Category: Primary Care Authors: Bimal H. Ashar Tags: Foreword Source Type: research

The Physical Examination as Ritual
The privilege of examining a patient is a skill of value beyond its diagnostic utility. A thorough physical examination is an important ritual that benefits patients and physicians. The concept of embodiment helps one understand how illness and pain further define and shape the lived experiences of individuals in the context of their race, gender, sexuality, and socioeconomic status. Understanding ritual in medicine, including the placebo effects of such rituals, reaffirms the centrality of the physical examination to the process of building strong physician-patient relationships. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 27, 2018 Category: Primary Care Authors: Cari Costanzo, Abraham Verghese Source Type: research

The Role of Technology in the Bedside Encounter
Technology has the potential to both distract and reconnect providers with their patients. The widespread adoption of electronic medical records in recent years pulls physicians away from time at the bedside. However, when used in conjunction with patients, technology has the potential to bring patients and physicians together. The increasing use of point-of-care ultrasound by physicians is changing the bedside encounter by allowing for real-time diagnosis with the treating physician. It is a powerful example of the way technology can be a force for refocusing on the bedside encounter. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 27, 2018 Category: Primary Care Authors: Andre Kumar, Gigi Liu, Jeff Chi, John Kugler Source Type: research

Diagnostic Errors and the Bedside Clinical Examination
Diagnostic errors are common in clinical practice and lead to adverse patient outcomes. Systematic reviews have shown that inadequate history taking and physical examination lead to a plurality, if not a majority, of diagnostic errors. Recent advances in cognitive science have also shown that unconscious biases likely contribute to many diagnostic errors. Research into diagnostic error has been hampered by methodologic inconsistency and a paucity of studies in real-world clinical settings. The best evidence indicates that educational interventions to reduce diagnostic error should give physicians feedback about clinical ou...
Source: Medical Clinics of North America - April 27, 2018 Category: Primary Care Authors: Bennett W. Clark, Arsalan Derakhshan, Sanjay V. Desai Source Type: research

The Electronic Health Record and the Clinical Examination
This review examines how the adoption of the electronic health record (EHR) has changed the most fundamental unit of medicine: the clinical examination. The impact of the EHR on the clinical history, physical examination, documentation, and the doctor-patient relationship is described. The EHR now has a dominant role in clinical care and will be a central factor in clinical work of the future. Conversation needs to be shifted toward defining best practices with current EHRs inside and outside of the examination room. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 27, 2018 Category: Primary Care Authors: Helene F. Hedian, Jeremy A. Greene, Timothy M. Niessen Source Type: research

Communication and Ethics in the Clinical Examination
At the heart of every effective patient-physician interaction is a relationship that is built on trust. Cultivating sound communication skills coupled with the awareness and application of ethical principles is integral to this process. One of the foremost challenges in competent practice is negotiating situations that arise at the bedside when such issues as patient autonomy, differing world views, honesty, and cost stewardship come into conflict. It is essential for health care providers to consider how to detect and prioritize these issues as they advocate for high-quality and patient-centered care. (Source: Medical Cli...
Source: Medical Clinics of North America - April 27, 2018 Category: Primary Care Authors: Sharon Onguti, Sherine Mathew, Christine Todd Source Type: research

Improving Observational Skills to Enhance the Clinical Examination
For much of the 20th century, educators lacked evidence that teaching observational skills could benefit modern medicine. But in 2001, a statistical model emerged that supported the effectiveness of teaching observational skills to medical students using a museum-based curriculum. The story that led to that ground-breaking study, and the consequences that sprung from it, is retold here, traveling from the darkened caves in the foothills of France to the brightly lit galleries of the Yale center for British art. It never would have happened without the indelible mark made by one curious man ’s journey. (Source: Medica...
Source: Medical Clinics of North America - April 27, 2018 Category: Primary Care Authors: Stephen W. Russell Source Type: research

Patient-Centered Bedside Rounds and the Clinical Examination
Bedside hospital rounds promote patient-centered care in teaching and nonteaching settings. Patients and families prefer bedside rounds and provider acceptance is increasing. Efficient bedside rounds with an interprofessional team or with learners requires preparation of the patient and the rounding team. Bedside “choreography” provides structure and sets expectations for time spent in the room. By using relationship-centered communication, rounds can be both patient proximate and patient centered. The clinical examination can be integrated into the flow of the presentation and case discussion. Patient a nd pro...
Source: Medical Clinics of North America - April 27, 2018 Category: Primary Care Authors: Peter R. Lichstein, Hal H. Atkinson Source Type: research

The Clinical Examination and Socially At-Risk Populations
We describe strategies for relationship-centered care within routine encounters. Our goal is to train clinicians to mitigate differences and reduce disparities in health care delivery. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 27, 2018 Category: Primary Care Authors: Karly A. Murphy, Alejandra Ellison-Barnes, Erica N. Johnson, Lisa A. Cooper Source Type: research

Clinical Skills Assessment in the Twenty-First Century
This article summarizes contemporary approaches to clinical skills assessment that, if more widely adopted, could support the maintenance and reinvigoration of bedside clinical skills. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 27, 2018 Category: Primary Care Authors: Andrew Elder Source Type: research

Clinical Examination Component of Telemedicine, Telehealth, mHealth, and Connected Health Medical Practices
Telemedicine and telehealth are the practices of medicine at a distance. Performing the equivalent of a complete clinical examination by telemedicine would be unusual. However, components of a more traditional clinical examination are part of the telemedicine workup for specific conditions. Telemedicine clinical examinations are facilitated, and enhanced, through the integration of a class of medical devices referred to as telemedicine peripherals (eg, electronic stethoscopes, tele-ophthalmoscopes, video-otoscopes, and so forth). Direct-to-consumer telehealth is a rapidly expanding segment of the health care service indust...
Source: Medical Clinics of North America - April 27, 2018 Category: Primary Care Authors: Ronald S. Weinstein, Elizabeth A. Krupinski, Charles R. Doarn Source Type: research

CME Accreditation Page
(Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 27, 2018 Category: Primary Care Source Type: research

Clinical Examination
MEDICAL CLINICS OF NORTH AMERICA (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 27, 2018 Category: Primary Care Authors: Brian T. Garibaldi Source Type: research

Copyright
ELSEVIER (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 27, 2018 Category: Primary Care Source Type: research

Forthcoming Issues
Substance Use and Addiction Medicine (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 27, 2018 Category: Primary Care Source Type: research

Contributors
BIMAL H. ASHAR, MD, MBA, FACP (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 27, 2018 Category: Primary Care Source Type: research

Contents
Bimal H. Ashar (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 27, 2018 Category: Primary Care Source Type: research

Pharmacotherapy for Alcohol Use Disorder
Alcohol use disorder is a common, destructive, and undertreated disease. As understanding of alcohol use disorder has evolved, so has our ability to manage patients with pharmacotherapeutic agents in addition to nondrug therapy, including various counseling strategies. Providers now have a myriad of medications, both approved and not approved by the US Food and Drug Administration, to choose from and can personalize care based on treatment goals, comorbidities, drug interactions, and drug availability. This review explores these treatment options and offers the prescriber practical advice regarding when each option may or ...
Source: Medical Clinics of North America - April 26, 2018 Category: Primary Care Authors: Stephen R. Holt, Daniel G. Tobin Source Type: research

The Physical Examination as Ritual
The privilege of examining a patient is a skill of value beyond its diagnostic utility. A thorough physical examination is an important ritual that benefits patients and physicians. The concept of embodiment helps one understand how illness and pain further define and shape the lived experiences of individuals in the context of their race, gender, sexuality, and socioeconomic status. Understanding ritual in medicine, including the placebo effects of such rituals, reaffirms the centrality of the physical examination to the process of building strong physician-patient relationships. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 10, 2018 Category: Primary Care Authors: Cari Costanzo, Abraham Verghese Source Type: research

The Role of Technology in the Bedside Encounter
Technology has the potential to both distract and reconnect providers with their patients. The widespread adoption of electronic medical records in recent years pulls physicians away from time at the bedside. However, when used in conjunction with patients, technology has the potential to bring patients and physicians together. The increasing use of point-of-care ultrasound by physicians is changing the bedside encounter by allowing for real-time diagnosis with the treating physician. It is a powerful example of the way technology can be a force for refocusing on the bedside encounter. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 10, 2018 Category: Primary Care Authors: Andre Kumar, Gigi Liu, Jeff Chi, John Kugler Source Type: research

Diagnostic Errors and the Bedside Clinical Examination
Diagnostic errors are common in clinical practice and lead to adverse patient outcomes. Systematic reviews have shown that inadequate history taking and physical examination lead to a plurality, if not a majority, of diagnostic errors. Recent advances in cognitive science have also shown that unconscious biases likely contribute to many diagnostic errors. Research into diagnostic error has been hampered by methodologic inconsistency and a paucity of studies in real-world clinical settings. The best evidence indicates that educational interventions to reduce diagnostic error should give physicians feedback about clinical ou...
Source: Medical Clinics of North America - April 10, 2018 Category: Primary Care Authors: Bennett W. Clark, Arsalan Derakhshan, Sanjay V. Desai Source Type: research

The Electronic Health Record and the Clinical Examination
This review examines how the adoption of the electronic health record (EHR) has changed the most fundamental unit of medicine: the clinical examination. The impact of the EHR on the clinical history, physical examination, documentation, and the doctor-patient relationship is described. The EHR now has a dominant role in clinical care and will be a central factor in clinical work of the future. Conversation needs to be shifted toward defining best practices with current EHRs inside and outside of the examination room. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 10, 2018 Category: Primary Care Authors: Helene F. Hedian, Jeremy A. Greene, Timothy M. Niessen Source Type: research

Communication and Ethics in the Clinical Examination
At the heart of every effective patient-physician interaction is a relationship that is built on trust. Cultivating sound communication skills coupled with the awareness and application of ethical principles is integral to this process. One of the foremost challenges in competent practice is negotiating situations that arise at the bedside when such issues as patient autonomy, differing world views, honesty, and cost stewardship come into conflict. It is essential for health care providers to consider how to detect and prioritize these issues as they advocate for high-quality and patient-centered care. (Source: Medical Cli...
Source: Medical Clinics of North America - April 10, 2018 Category: Primary Care Authors: Sharon Onguti, Sherine Mathew, Christine Todd Source Type: research

Improving Observational Skills to Enhance the Clinical Examination
For much of the 20th century, educators lacked evidence that teaching observational skills could benefit modern medicine. But in 2001, a statistical model emerged that supported the effectiveness of teaching observational skills to medical students using a museum-based curriculum. The story that led to that ground-breaking study, and the consequences that sprung from it, is retold here, traveling from the darkened caves in the foothills of France to the brightly lit galleries of the Yale center for British art. It never would have happened without the indelible mark made by one curious man ’s journey. (Source: Medica...
Source: Medical Clinics of North America - April 10, 2018 Category: Primary Care Authors: Stephen W. Russell Source Type: research

Patient-Centered Bedside Rounds and the Clinical Examination
Bedside hospital rounds promote patient-centered care in teaching and nonteaching settings. Patients and families prefer bedside rounds and provider acceptance is increasing. Efficient bedside rounds with an interprofessional team or with learners requires preparation of the patient and the rounding team. Bedside “choreography” provides structure and sets expectations for time spent in the room. By using relationship-centered communication, rounds can be both patient proximate and patient centered. The clinical examination can be integrated into the flow of the presentation and case discussion. Patient a nd pro...
Source: Medical Clinics of North America - April 10, 2018 Category: Primary Care Authors: Peter R. Lichstein, Hal H. Atkinson Source Type: research

The Clinical Examination and Socially At-Risk Populations
We describe strategies for relationship-centered care within routine encounters. Our goal is to train clinicians to mitigate differences and reduce disparities in health care delivery. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 10, 2018 Category: Primary Care Authors: Karly A. Murphy, Alejandra Ellison-Barnes, Erica N. Johnson, Lisa A. Cooper Source Type: research

Clinical Skills Assessment in the Twenty-First Century
This article summarizes contemporary approaches to clinical skills assessment that, if more widely adopted, could support the maintenance and reinvigoration of bedside clinical skills. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - April 10, 2018 Category: Primary Care Authors: Andrew Elder Source Type: research