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How communication affects prescription decisions in consultations for acute illness in children: a systematic review and meta-ethnography
Conclusions: Misunderstandings occurred due to parents and clinicians talking at cross purposes about the 'seriousness' of the illness and because parents' expressions of concern or requests for additional information were sometimes perceived as a challenge to the clinicians' diagnosis or treatment decision. This modifiable problem may be an important contribution to the unnecessary and unwanted prescribing of antibiotics. Primary care clinicians should be offered training to understand parent communication primarily as expressions of concern or attempts at understanding and always to check rather than infer parental expectations.
Source: BMC Family Practice - April 8, 2014 Category: Primary Care Authors: Christie CabralJeremy HorwoodAlastair HayPatricia Lucas Source Type: research

The family in the Pediatric Unit: living with rules and hospital routines.
Abstract The study aimed to know, in Foucault's view, how the family caregiver of the child deals with the rules and routines in the hospital. Descriptive qualitative study, conducted in the second half of 2011. It had the Grounded Theory as methodological framework. It was developed in the pediatric unit of a university hospital in southern Brazil, with eighteen family caregivers. The data collection was performed by semi-structured interviews and the analysis through open, axial and selective coding. It was noticed that the family tends to conform to such rules and routines in the hospital, but recognizes the im...
Source: Revista Brasileira de Enfermagem - April 1, 2014 Category: Nursing Authors: Xavier DM, Gomes GC, Santos SS, Lunardi VL, Pintanel AC, Erdmann AL Tags: Rev Bras Enferm Source Type: research

Interventions focusing on psychosocial risk factors for patients with non-chronic low back pain in primary care--a systematic review
Conclusion. Among the wide range of psychosocial risk factors, research has focused mainly on pain beliefs and coping skills, with disappointing results. Extended theoretical models integrating several psychosocial factors and multicomponent interventions are probably required to meet the challenge of LBP.
Source: Family Practice - July 22, 2014 Category: Primary Care Authors: Ramond-Roquin, A., Bouton, C., Gobin-Tempereau, A.-S., Airagnes, G., Richard, I., Roquelaure, Y., Huez, J.-F. Tags: Review Source Type: research

New and Established Patient E/M Definitions (CMS vs. CPT®)
I get lot of requests from readers of The Happy Hospitalist asking how to know if a patient is a new or established patient.  Identifying the correct classification will prevent delays or denials of payment.  Many evaluation and management (E/M) codes are by definition described as new or established.  This lecture will attempt to explain various important clinical aspects related to this determination.  Keep in mind while the Centers For Medicare & Medicaid Services (CMS) uses  Current Procedural Terminology (CPT) codes, CMS definitions do not always agree with CPT® definitions.  This di...
Source: The Happy Hospitalist - February 27, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

Optimizing antibiotic prescribing for acutely ill children in primary care (ERNIE2 study protocol, part B): a cluster randomized, factorial controlled trial evaluating the effect of a point-of-care C-reactive protein test and a brief intervention combined with written safety net advice
DiscussionThis is a unique multifaceted intervention, in that it targets both physicians and parents by aiming specifically at their uncertainty and concerns during the consultation. Both interventions are easy to implement without special training. When proven effective, they could offer a feasible way to decrease inappropriate antibiotic prescribing for children in family practice and thus avoid emergence of bacterial resistance, side effects and unnecessary healthcare costs. Moreover, the observational part of the study will increase our insight in the course, management and parent's concern of acute illness in children...
Source: BMC Pediatrics - Latest articles - October 2, 2014 Category: Pediatrics Authors: Marieke LemiengreJan VerbakelTine De BurghgraeveBert AertgeertsFrans De BaetsFrank BuntinxAn De Sutter Source Type: research

The shortage of critical care physicians: Is there a solution?
Conclusions: Family Practice is the second largest collective group of physicians in the United States—second only to internal medicine. In most of rural America, where there are limited physicians serving the population, family practitioners fill the gap and provide services otherwise unavailable to those patients. This group that can potentially be trained in critical care and help solve the crisis has been prevented from doing so.
Source: Journal of Critical Care - August 11, 2014 Category: Intensive Care Authors: Manuel Lois Tags: Letters Source Type: research

Tools for primary care patient safety: a narrative review
Background: Patient safety in primary care is a developing field with an embryonic but evolving evidence base. This narrative review aims to identify tools that can be used by family practitioners as part of a patient safety toolkit to improve the safety of the care and services provided by their practices. Methods: Searches were performed in 6 healthcare databases in 2011 using 3 search stems; location (primary care), patient safety synonyms and outcome measure synonyms. Two reviewers analysed the results using a numerical and thematic analyses. Extensive grey literature exploration was also conducted. Results: Overall, 1...
Source: BMC Family Practice - October 26, 2014 Category: Primary Care Authors: Rachel SpencerStephen Campbell Source Type: research

Effectiveness of behavioural weight loss interventions delivered in a primary care setting: a systematic review and meta-analysis
Conclusion. Behavioural weight loss interventions in primary care yield very small reductions in body weight, which are unlikely to be clinically significant. More effective management strategies are needed for the treatment of overweight and obesity.
Source: Family Practice - November 18, 2014 Category: Primary Care Authors: Booth, H. P., Prevost, T. A., Wright, A. J., Gulliford, M. C. Tags: Review Source Type: research

Don't forget to floss . . . and take your drugs
An MD friend is a substance abuse counselor here in Massachusetts.  She reported to me that a substantial percentage of her clients have been able to maintain their addiction through supplies of opiates prescribed by dentists. In all the recent talk about excessive use of opiates, I had never heard about this source.So I wondered if there has been any study of this by the profession or coverage of this issue by the media.  After a search, I found this 2010 report from the Tufts Health Care Institute Program on Opioid Risk Management.  Excerpts:The top specialty prescribing IR [immediate release] opioids in t...
Source: Running a hospital - February 1, 2015 Category: Health Managers Source Type: blogs

Effectiveness of knowledge translation tools addressing multiple high-burden chronic diseases affecting older adults: protocol for a systematic review alongside a realist review
Introduction The burden of chronic disease is a global phenomenon, particularly among people aged 65 years and older. More than half of older adults have more than one chronic disease and their care is not optimal. Chronic disease management (CDM) tools have the potential to meet this challenge but they are primarily focused on a single disease, which fails to address the growing number of seniors with multiple chronic conditions. Methods and analysis We will conduct a systematic review alongside a realist review to identify effective CDM tools that integrate one or more high-burden chronic diseases affecting older a...
Source: BMJ Open - February 3, 2015 Category: Journals (General) Authors: Kastner, M., Perrier, L., Hamid, J., Tricco, A. C., Cardoso, R., Ivers, N. M., Liu, B., Marr, S., Holroyd-Leduc, J., Wong, G., Graves, L., Straus, S. E. Tags: Open access, General practice / Family practice, Mental health, Neurology, Respiratory medicine, Rheumatology, Diabetes and Endocrinology Protocol Source Type: research

Over-reassurance and undersupport after a 'false alarm': a systematic review of the impact on subsequent cancer symptom attribution and help seeking
Conclusions In conclusion, over-reassurance and undersupport of patients after a false alarm can undermine help seeking in the case of new or recurrent potential cancer symptoms, highlighting the need for appropriate patient information when investigations rule out cancer.
Source: BMJ Open - February 4, 2015 Category: Journals (General) Authors: Renzi, C., Whitaker, K. L., Wardle, J. Tags: Open access, Communication, General practice / Family practice, Health services research, Oncology, Public health, Qualitative research Source Type: research

Frailty: Identifying elderly patients at high risk of poor outcomes.
CONCLUSION: Despite its importance, little attention has been given to the concept of frailty in family medicine. Frailty is easily overlooked because its manifestations can be subtle, slowly progressive, and thus dismissed as normal aging; and physician training has been focused on specific medical diseases rather than overall vulnerability. For primary care physicians, recognition of frailty might help them provide appropriate counseling to patients and family members about the risks of medical interventions. PMID: 25767167 [PubMed - as supplied by publisher]
Source: Canadian Family Physician Medecin de Famille Canadien - March 1, 2015 Category: Primary Care Authors: Lee L, Heckman G, Molnar FJ Tags: Can Fam Physician Source Type: research

A comprehensive framework and key guideline recommendations for the provision of evidence-based breast cancer survivorship care within the primary care setting
Conclusions. This framework may serve as a tool to remind PCPs about issues impacting breast cancer survivors, as well as the evidence-based recommendations and resources to provide the associated care.
Source: Family Practice - March 24, 2015 Category: Primary Care Authors: Luctkar-Flude, M., Aiken, A., McColl, M. A., Tranmer, J. Tags: Review Source Type: research

Effectiveness of home visiting in reducing partner violence for families experiencing abuse: a systematic review
Conclusions. Home visiting interventions that support abused women explicit to stop IPV seem to be effective in reducing IPV. However, it is not known whether these results are effective in the long term.
Source: Family Practice - May 27, 2015 Category: Primary Care Authors: Prosman, G.-J., Lo Fo Wong, S. H., van der Wouden, J. C., Lagro-Janssen, A. L. Tags: Review Source Type: research

Increased risk for atypical fractures associated with bisphosphonate use
Conclusion: Results suggest there is an increased risk for atypical fractures associated with bisphosphonates and raises awareness to the potential complications related with bisphosphonates. These findings warrant the comprehensive evaluation of patients before initiating bisphosphonate therapy and highlights the need for additional medical decision analyses in future studies to compare the benefit over potential harms of bisphosphonate therapy.
Source: Family Practice - May 27, 2015 Category: Primary Care Authors: Lee, S., Yin, R. V., Hirpara, H., Lee, N. C., Lee, A., Llanos, S., Phung, O. J. Tags: Epidemiology Source Type: research