Here is information regarding free access to BMJ's excellent Clinical Evidence resource.
As of this posting, the general procedure is going to this web page and entering "United Health Foundation 2008" in the password field.
And from what I can tell, this is one of the few resources that isn't available via the Mayo library.
Tuesday, March 30, 2010
Springboard message from Dr. John Bachman
http://hbr.org/fixing-health-care
Last week with the Health Care Reform bill passed and Dr. Terry McGeeney's presentation, I thought we should have three articles from Harvard Business Review's latest issue.
The first has great graphics: http://hbr.org/2010/04/what-drives-high-health-care-costs-and-how-to-fight-back/ar/1
The next two are very helpful in setting the stage for change.
The first turning doctors into leaders http://hbr.org/2010/04/turning-doctors-into-leaders/ar/1
and the second fixing health care http://hbr.org/2010/04/fixing-health-care-on-the-front-lines/ar/1
Great stuff for forward thinking people.
John
Saturday, March 27, 2010
MAFP presentation
Here's the link to the presentation on a web application for clinical documentation
http://docs.google.com/present/view?id=dcz8t5wb_1172hpfpdbg4
Here's the link for the comment form and to receive notification when soapnote.org is released: http://bit.ly/dvypLF
http://docs.google.com/present/view?id=dcz8t5wb_1172hpfpdbg4
Here's the link for the comment form and to receive notification when soapnote.org is released: http://bit.ly/dvypLF
Wednesday, March 24, 2010
April 2010 Journal Club
WHEN: TUESDAY, APRIL 13, 2010 AT 6 PM.
WHO: Dr. Ana Caro will be leading the discussion. Dr. Tara Kaufman is the staff facilitator.
WHERE: TBA
ARTICLE FOR DISCUSSION: The role of calcium score and CT angiography in the medical management of patients with normal myocardial perfusion imaging HERE
RSVP with Tammy Younge so we can figure out logistics.
About Journal Club
Journal club is a monthly meeting the second Tuesday every month. It intends to focus on the evidence that supports the care we provide. Usually we'll be reviewing a single journal article.
To prepare, we ask that you read the article.
Most of all it's supposed to be relevant and interesting.
Email me if you have ideas for articles for discussion and/or you'd like to facilitate a discussion.
WHO: Dr. Ana Caro will be leading the discussion. Dr. Tara Kaufman is the staff facilitator.
WHERE: TBA
ARTICLE FOR DISCUSSION: The role of calcium score and CT angiography in the medical management of patients with normal myocardial perfusion imaging HERE
RSVP with Tammy Younge so we can figure out logistics.
About Journal Club
Journal club is a monthly meeting the second Tuesday every month. It intends to focus on the evidence that supports the care we provide. Usually we'll be reviewing a single journal article.
To prepare, we ask that you read the article.
Most of all it's supposed to be relevant and interesting.
Email me if you have ideas for articles for discussion and/or you'd like to facilitate a discussion.
From N. Rasmussen--Article of interest re: Impact of apathy on glycemic control
To My Colleagues,
Attached is the link to a 2008 article published in Diabetes Research and Clinical Practice on the impact of apathy on glycemic control in diabetes. Traditionally, apathy has been viewed as part and parcel of depression. However, more recently in the psychology and psychiatry community, apathy is viewed by many as an independent or at least semi-independent condition separate from clinical depression. The attached study found that over half of the diabetic sample had clinically significant apathy without a diagnosis of depression, and, furthermore, the apathy was correlated with poorer diabetic outcomes compared to the non-apathetic patients regarding HbA1c and self-care.
Two issues seem to be relevant to the family physician regarding the apathy literature and diabetes. First, virtually all depression tests mingle apathy items with other depressive symptoms and thus it is not always apparent that apathy type symptoms constitute the predominant cluster in a diagnosis of depression. Second, this has pharmacologic treatment implications – prescribing an SSRI may only exacerbate the apathy when perhaps, based on what I read, a dopamine agent may be more effective. The obvious aim of course would be to decrease the apathy and thereby improve patient self-care and diabetic control.
HERE is the article
Attached is the link to a 2008 article published in Diabetes Research and Clinical Practice on the impact of apathy on glycemic control in diabetes. Traditionally, apathy has been viewed as part and parcel of depression. However, more recently in the psychology and psychiatry community, apathy is viewed by many as an independent or at least semi-independent condition separate from clinical depression. The attached study found that over half of the diabetic sample had clinically significant apathy without a diagnosis of depression, and, furthermore, the apathy was correlated with poorer diabetic outcomes compared to the non-apathetic patients regarding HbA1c and self-care.
Two issues seem to be relevant to the family physician regarding the apathy literature and diabetes. First, virtually all depression tests mingle apathy items with other depressive symptoms and thus it is not always apparent that apathy type symptoms constitute the predominant cluster in a diagnosis of depression. Second, this has pharmacologic treatment implications – prescribing an SSRI may only exacerbate the apathy when perhaps, based on what I read, a dopamine agent may be more effective. The obvious aim of course would be to decrease the apathy and thereby improve patient self-care and diabetic control.
HERE is the article
Keloids
A response to this post.
Can your really achieve a good clinical/cosmetic response in keloids with OS/P?. Does size or location matter? Any experiences?
Mirko.
-----------------------------
Mirko,
I looked. A review of the literature done 2 years ago showed evidence for cryo or cryo + intralesional steroids poor quality evidence. . (J Plast Reconstr Aesthet Surg. 2008;61(1):4-17. Epub 2007 Jul 19.) One small n study since then that was prospective and randomized showed the combination better than cryo alone. J Cosmet Dermatol. 2007 Dec;6(4):258-61.
My preference has been to inject intralesional steroids in small amounts of 0.1 to 0.2 ml of 1:1 triam 40 mg/ml and Bupivacaine or Xylo with multiple injection points using a 27-30 g needle on an every 2-3 week basis until desired result. Anecdotally this works very well. As a result of the above evidence, I'll now try a pre-cryo with 10-15 seconds of freeze prior to injecting. FYI, I am now using a Jet injector (Madajet) for intralesional steroid placement in the Procedure Clinic - takes seconds for multiple injections and blows it in nicely intralesionally with less pain.
I have excised large keloids previously. Post operative steroid into wound margins beginning at suture removal 1-2 weeks after excision with tight wrapping for 18+ hours per day probably/may/anecdotally reduces recurrence. A low tension closure is key (since as you've seen on some people with excisions with higher tension closures which weren't undermined, they get keloids whether they are prone to them or not). Topical steroids (high potency), imiquimod and tacrolimus, and a host of other immune modulators have also been studied to inhibit alpha-2-macroglobulin which is a collagenase inhibitor and thus increase collegenase activity (blah blah technical blah blah). Cheap works, so stick with steroids until someone proves that one of these others is clearly superior.
Steve
Can your really achieve a good clinical/cosmetic response in keloids with OS/P?. Does size or location matter? Any experiences?
Mirko.
-----------------------------
Mirko,
I looked. A review of the literature done 2 years ago showed evidence for cryo or cryo + intralesional steroids poor quality evidence. . (J Plast Reconstr Aesthet Surg. 2008;61(1):4-17. Epub 2007 Jul 19.) One small n study since then that was prospective and randomized showed the combination better than cryo alone. J Cosmet Dermatol. 2007 Dec;6(4):258-61.
My preference has been to inject intralesional steroids in small amounts of 0.1 to 0.2 ml of 1:1 triam 40 mg/ml and Bupivacaine or Xylo with multiple injection points using a 27-30 g needle on an every 2-3 week basis until desired result. Anecdotally this works very well. As a result of the above evidence, I'll now try a pre-cryo with 10-15 seconds of freeze prior to injecting. FYI, I am now using a Jet injector (Madajet) for intralesional steroid placement in the Procedure Clinic - takes seconds for multiple injections and blows it in nicely intralesionally with less pain.
I have excised large keloids previously. Post operative steroid into wound margins beginning at suture removal 1-2 weeks after excision with tight wrapping for 18+ hours per day probably/may/anecdotally reduces recurrence. A low tension closure is key (since as you've seen on some people with excisions with higher tension closures which weren't undermined, they get keloids whether they are prone to them or not). Topical steroids (high potency), imiquimod and tacrolimus, and a host of other immune modulators have also been studied to inhibit alpha-2-macroglobulin which is a collagenase inhibitor and thus increase collegenase activity (blah blah technical blah blah). Cheap works, so stick with steroids until someone proves that one of these others is clearly superior.
Steve
Springboard message from Dr. Bachman
This is the presentation from Terry McGinney, M.D., M.B.A. HERE
I would encourage residents to sign up for the Delta Exchange:
http://www.transformed.com/Delta-Exchange/index.cfm
It is free for our residents. Residents should also check out the site for preparing you for practice (P4) :
http://www.transformed.com/p4.cfm
At dinner with Terry McGinney at our home, there was discussion of the inadequacy of teaching in this country for simple procedures. One of our residents pointed out that they were uncertain of wart cryotherapy and how long to hold the freeze.
http://www.aafp.org/afp/2004/0515/p2365.html is an article that would be useful
The freeze times are HERE.
I would encourage residents to sign up for the Delta Exchange:
http://www.transformed.com/Delta-Exchange/index.cfm
It is free for our residents. Residents should also check out the site for preparing you for practice (P4) :
http://www.transformed.com/p4.cfm
At dinner with Terry McGinney at our home, there was discussion of the inadequacy of teaching in this country for simple procedures. One of our residents pointed out that they were uncertain of wart cryotherapy and how long to hold the freeze.
http://www.aafp.org/afp/2004/0515/p2365.html is an article that would be useful
The freeze times are HERE.
Springboard Club from Dr. Bachman
Autism is something we are screening for on a regular basis This article is useful to review the topic HERE This table shows the team members to help in the case HERE
As you read this remember it was written by a third year resident. We have people just as talented in our group
Teaching As we move forward with the transformation of family medicine I think this article showed an excellent project involving quality improvement with a preseptorship in offices
HERE
As you read this remember it was written by a third year resident. We have people just as talented in our group
Teaching As we move forward with the transformation of family medicine I think this article showed an excellent project involving quality improvement with a preseptorship in offices
HERE
More than 1,000 medical students have successfully completed projects in Nebraska communities since the inception of the program. UNCOM student projects have won national awards at a variety of medical education conferences. 2 Sample project instructions, descriptions, timelines, examples of student write-ups, and other pertinent documents can be obtained by contacting the author at ppaulman@unmc.edu.
Conclusion The UNCOM Clinical Quality Improvement Project has been a successful collaboration between the College of Medicine, community family physician preceptors, and the Nebraska Academy of Family Physicians.
Springboard message Dr. Bachman
The medical literature this week went south with nothing really outstanding…. so I chose this click image (above).
The graph talks about retention of information If you chat with a patient and just talk, if you show pictures, or if you combine both. If you look at the figure it will make a big difference in how you present to your patients as well as with your colleagues… Visual and Verbal together are the way to go… Pull out a piece of paper and draw for patients! .I have included this web link http://www.osha.gov/doc/outreachtraining/htmlfiles/traintec.html
*****************************************************************************
For young leaders who would like to meet in Cancun!
Attention emerging leaders in Family Medicine:
Are you interested in attending the World Wonca Conference in Cancun, Mexico in May 2010? Would you like to learn more about global family medicine while working with other national colleges and Wonca regions? (www.wonca2010cancun.com)
Leaders of the AAFP and the AAFP Foundation have made available travel grants of $1,000 for family medicine residents, new physicians (7 years or less since residency graduation) and medical students to attend this conference. The World Conference will be held from 19-23 May 2010. There will be at least 5 travel grants available; more grants may be available based on funding.
To apply:
Please submit by 1 April 2010
(1) a letter of interest, no longer than 1 page, that indicates why you want to attend.
(2) a resume or abbreviated CV of no longer than 1 page.
(3) a letter of recommendation from your residency program director, department chair, or other knowledgeable faculty/colleague.
Submit your information to
MAIL:
AAFP Foundation
Attn: Phyllis Naragon
11400 Tomahawk Creek Parkway
Leawood, KS 66211
FAX:
913.906.6095
EMAIL as PDF:
pnaragon@aafp.org
Ashley DeVilbiss Bieck, MPA
Student Interest Manager
American Academy of Family Physicians
11400 Tomahawk Creek Pkwy
Leawood, KS 66211
913-906-6000 x6722
913-906-6091, fax
adevilbi@aafp.org
Springboard message from Dr. Bachman
Recently there was a discussion regarding the role of family physicians in using methotrexate in rheumatoid arthritis. The conversation was whether family doctors should start methotrexate treatment without referral vs. referring patients to a rheumatologist because of legal consideration. Whenever disagreement over a topic is brought up it can become a learning issue.
Methotrexate for family physicians is 10 years old, but remains an excellent review with summaries of initiation and follow-up http://www.aafp.org/afp/20001001/1607.html
Methotrexate concentrates in the kidneys, gallbladder, and spleen, as well as in the liver. Renal excretion eliminates 60 to 95 percent of a dose. Tubular secretion, reabsorption and glomerular filtration are all involved in the renal elimination of methotrexate. Therefore, methotrexate is contraindicated in any patient with a creatinine clearance of less than 50 mL per minute.
The UK uses shared care agreements with doctors who initiate the treatment being legally liable http://www.lmsg.nhs.uk/SharedCare/pdfdocs/MethotrexateSCAv2_1_200806.pdf
American Family Physician editorial talks of early referral to rheumatologist
http://www.ncbi.nlm.nih.gov/pubmed/16190501?dopt=Abstract
American College of Rheumatology 2008 recommendations states physician although in references talks about referring to a rheumatogist in other literature in the first three months of RA
http://www3.interscience.wiley.com/cgi-bin/fulltext/119635887/HTMLSTART?CRETRY=1&SRETRY=0
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689523/?tool=pubmed Shows recomendatons for methotrexate and variation among rheumatologist
Law suits were certainly an issue. The ones I found were when doctors just gave the wrong treatments. ie. In the treatment of rheumatoid arthritis and psoriasis there are given MTX doses ... she had been prescribed by her family doctor 20 mg/day MTX for 8 days. This caused the patient to die
So be careful and make sure when you see methotrexate on the list that you note this is one dangerous medication.
TEACHING
We all know about STFM Here is another organization that gets people out of their boxes in teaching students.
http://www.iamse.org/ Check out the social networking issues
Springboard club (from Dr. Bachman)
Rotator cuff tear; link to see pictures http://content.nejm.org/cgi/content/full/358/20/2138 I thought this picture was useful pull it up when you are checking someone!
MEETINGS
Mayo traditionally has a session at the practice improvement meeting If you have a project or effort that would take 15 minutes to present let Kurt Angstman know and we will submit it as part of
A Mayo seminar. People who have done this include Kurt, John Wilkinson, Steve Adamson, Tom Harmon, Vic Yapunuvich. The place is packed Of course you can go it alone but I guarantee you will get in if you join this meeting
Conference on Practice Improvement: Assembling the Patient-centered Team
Conference Location: San Antonio, Texas
Conference Dates: December 2-5, 2010
TEACHING
http://www.stfm.org/documents/0109TeachPhy.pdf Check out the last page on the videos available I will see if we can get our department to get this for all of us who teach
GRANT APPLICATION
Pfizer/American Academy of Family Physicians Foundation Visiting Professorship Program in Family Medicine
Grantor:American Academy of Family Physicians Foundation/Pfizer
Region:All Regions
Closes:03/19/2010
Maximum:$7,500
Pfizer/American Academy of Family Physicians Foundation Visiting Professorship Program in Family Medicine
Host a Prominent Physician-Scientist On Us
Apply to receive three days of teaching and interaction during the 2010-2011 academic year at your program or school. Six institutions will be awarded $7,500 each to invite a prominent physician-scientist of their choosing. The guest faculty may give lectures, as well as participate in rounds, seminars and conferences.
Awards are intended to cover the visiting professor’s honorarium, travel expenses and other direct expenses incurred by the host institution in conducting program activities. Amounts allotted for each item are at the discretion of the host institution.
Interested in applying in 2010?
Eligibility
Family Medicine departments within a U.S. medical school or any accredited Family Medicine residency program may apply. Applications from community-based programs are encouraged.
Grant Rules
* Each hospital may submit only one application.
* Submissions must originate from the Chair of the Family Medicine Department or the Residency Director.
* This program will fund just one visit per year per visiting professor.
* A proposed Pfizer Visiting Professor should accept only one nomination per year. Candidates are required to verify that they have not accepted more than one nomination.
* Pfizer Visiting Professorships must consist of three full days of Pfizer-supported professional proceedings. Visits are not to be conducted as an adjunct to other planned meetings or events.
* A member of the Visiting Professorship Academic Advisory Board may not act as a Visiting Professor during his or her tenure on the board. In addition, the home institute of a member of the Academic Advisory Board may not host a Visiting Professor during the board member's tenure.
Application materials for 2010 are available below. All materials are due by March 19, 2010.
If you have questions:
Contact Perry A. Pugno, MD, MPH, CPE, AAFP Medical Education Director at (800)274-2237, Ext. 6700, or Susie Morantz, AAFP Foundation Program Manager at (800)274-2237, Ext 4470
American Academy of Family Physicians Foundation
11400 Tomahawk Creek Parkway, Suite 440
Leawood, KS 66211-2672
Toll free: (800) 274-2237
Phone: (913) 906-6000
Fax: (913) 906-6095
Link:http://www.aafpfoundation.org/online/foundation/home/programs/education/professorshipapp.html
Categories:Academic Medicine, Continuing Medical Education, Educational Exchange, Family Medicine, Medical Schools, Visiting Professorships
John
MEETINGS
Mayo traditionally has a session at the practice improvement meeting If you have a project or effort that would take 15 minutes to present let Kurt Angstman know and we will submit it as part of
A Mayo seminar. People who have done this include Kurt, John Wilkinson, Steve Adamson, Tom Harmon, Vic Yapunuvich. The place is packed Of course you can go it alone but I guarantee you will get in if you join this meeting
Conference on Practice Improvement: Assembling the Patient-centered Team
Conference Location: San Antonio, Texas
Conference Dates: December 2-5, 2010
TEACHING
http://www.stfm.org/documents/0109TeachPhy.pdf Check out the last page on the videos available I will see if we can get our department to get this for all of us who teach
GRANT APPLICATION
Pfizer/American Academy of Family Physicians Foundation Visiting Professorship Program in Family Medicine
Grantor:American Academy of Family Physicians Foundation/Pfizer
Region:All Regions
Closes:03/19/2010
Maximum:$7,500
Pfizer/American Academy of Family Physicians Foundation Visiting Professorship Program in Family Medicine
Host a Prominent Physician-Scientist On Us
Apply to receive three days of teaching and interaction during the 2010-2011 academic year at your program or school. Six institutions will be awarded $7,500 each to invite a prominent physician-scientist of their choosing. The guest faculty may give lectures, as well as participate in rounds, seminars and conferences.
Awards are intended to cover the visiting professor’s honorarium, travel expenses and other direct expenses incurred by the host institution in conducting program activities. Amounts allotted for each item are at the discretion of the host institution.
Interested in applying in 2010?
Eligibility
Family Medicine departments within a U.S. medical school or any accredited Family Medicine residency program may apply. Applications from community-based programs are encouraged.
Grant Rules
* Each hospital may submit only one application.
* Submissions must originate from the Chair of the Family Medicine Department or the Residency Director.
* This program will fund just one visit per year per visiting professor.
* A proposed Pfizer Visiting Professor should accept only one nomination per year. Candidates are required to verify that they have not accepted more than one nomination.
* Pfizer Visiting Professorships must consist of three full days of Pfizer-supported professional proceedings. Visits are not to be conducted as an adjunct to other planned meetings or events.
* A member of the Visiting Professorship Academic Advisory Board may not act as a Visiting Professor during his or her tenure on the board. In addition, the home institute of a member of the Academic Advisory Board may not host a Visiting Professor during the board member's tenure.
Application materials for 2010 are available below. All materials are due by March 19, 2010.
If you have questions:
Contact Perry A. Pugno, MD, MPH, CPE, AAFP Medical Education Director at (800)274-2237, Ext. 6700, or Susie Morantz, AAFP Foundation Program Manager at (800)274-2237, Ext 4470
American Academy of Family Physicians Foundation
11400 Tomahawk Creek Parkway, Suite 440
Leawood, KS 66211-2672
Toll free: (800) 274-2237
Phone: (913) 906-6000
Fax: (913) 906-6095
Link:http://www.aafpfoundation.org/online/foundation/home/programs/education/professorshipapp.html
Categories:Academic Medicine, Continuing Medical Education, Educational Exchange, Family Medicine, Medical Schools, Visiting Professorships
John
Springboard Case from Dr. Bachman
The Mayo Proceedings had an article on pearls on thromboembolism. It also discussed using cases to present a review. The article has a nice style and makes some excellent points http://mayoclinicproceedings.com/content/84/12/1120.full Those wishing to plan presentations nationally might look at the format
"At the 2001 annual conference of the American College of Physicians, a new teaching format to aid physician learning, Clinical Pearls, was introduced. Clinical Pearls is designed with the 3 qualities of physician-learners in mind. First, we physicians enjoy learning from cases. Second, we like concise, practical points that we can use in our practice. Finally, we take pleasure in problem solving.
In the Clinical Pearls format, speakers present a number of short cases in their specialty to a general internal medicine audience. Each case is followed by a multiple-choice question answered live by attendees using an audience response system. The answer distribution is shown to attendees. The correct answer is then displayed and the speaker discusses teaching points, clarifying why one answer is most appropriate. Each case presentation ends with a Clinical Pearl, defined as a practical teaching point that is supported by the literature but generally not well known to most internists."
Clinical Pearls is currently one of the most popular sessions at the American College of Physicians meeting
*********
The quality and safety forum was awesome. Don Berwick rocks If you have never heard him this is a link to an excerpt of the presentation http://www.ihi.org/IHI/Programs/ConferencesAndSeminars/21stAnnualNationalForumonQualityImprovementinHealthCare.htm open the video clip it lasts about ten minutes
John
Springboard message from Dr. Bachman
Preventing infections when we break the skin.
Common things we do. Prepping patients- most of us use ChoraPrep. This article supports this use. It cuts the rate of staph infection in half.
HERE
The issue also has a brief review of reducing infections from procedures. Excerpt- In an attempt to reduce surgical morbidity, the Surgical Infection Prevention Project and the Surgical Care Improvement Project have outlined evidence-based recommendations, bundling several strategies into a comprehensive approach. They include the initial administration of perioperative antibiotics within one hour before surgery, the preoperative use of hair clippers or no hair removal (as opposed to shaving of hair), and the maintenance of normothermia during colorectal surgery. In summary, the weight of evidence suggests that chlorhexidine–alcohol should replace povidone–iodine as the standard for preoperative surgical scrubs. ARTICLE HERE
So do we keep using shaves? Do we select Iodine because of habit??
Finally, where do you go to get new ideas or better ways of doing things? There are a lot of conferences. One that often does not get on the radar is the Wall Street Journal's World Health Care Congress series on topics that bring national and international leaders to discuss issues. They are great. http://www.worldcongress.com/Events/
Mayo will have a significant presence at the May 13th meeting on Chronic Disease Management, but they are all good! If you see a conference topic you would like to present at one of the congress meetings, please let me know and I will help you get in.
John
Common things we do. Prepping patients- most of us use ChoraPrep. This article supports this use. It cuts the rate of staph infection in half.
HERE
The issue also has a brief review of reducing infections from procedures. Excerpt- In an attempt to reduce surgical morbidity, the Surgical Infection Prevention Project and the Surgical Care Improvement Project have outlined evidence-based recommendations, bundling several strategies into a comprehensive approach. They include the initial administration of perioperative antibiotics within one hour before surgery, the preoperative use of hair clippers or no hair removal (as opposed to shaving of hair), and the maintenance of normothermia during colorectal surgery. In summary, the weight of evidence suggests that chlorhexidine–alcohol should replace povidone–iodine as the standard for preoperative surgical scrubs. ARTICLE HERE
So do we keep using shaves? Do we select Iodine because of habit??
Finally, where do you go to get new ideas or better ways of doing things? There are a lot of conferences. One that often does not get on the radar is the Wall Street Journal's World Health Care Congress series on topics that bring national and international leaders to discuss issues. They are great. http://www.worldcongress.com/Events/
Mayo will have a significant presence at the May 13th meeting on Chronic Disease Management, but they are all good! If you see a conference topic you would like to present at one of the congress meetings, please let me know and I will help you get in.
John
Springboard message from Dr. Bachman
This week on hospital service we had a 95 year old frail male with evidence of a GI Bleed. What to do?
This article gave some insight. It was found in JAMA about the elderly. It has an excellent review on dealing with the frail elderly. HERE
This shows the life expectancy of older patients. HERE
There are some excellent tables on screening questions and suggestions. The accompaning commentary showed what prevention services Medicare provide <<Medicare.pdf>>
Finally the third article was useful in that it gave a rational approach to making decisions in the elderly about mammography.
HERE
*Conference on Practice Improvement: Assembling the Patient-centered
Team*
December 2-5, 2010 * San Antonio, Texas
Conference Web site: http://www.stfm.org/pic
Submission Deadline: March 15, 2010
In our progress in building the Medical Home at the 2009 Practice
Improvement Conference, an important theme surfaced: the need for
improved patient-centered care and the value of the well coordinated
multidisciplinary team.
The time constraints of modern medical care demand an evidence based
team effort that divides the workload in a manner that utilizes the
strengths of various team members to provide accurate, efficient, and
timely care of the patient. This can only be successful through
appropriate training and experiences which assure the involvement of
patients and their families in active planning of their own care.
The Conference on Practice Improvement is designed to continue the
process of illustrating the development of the medical home model. The
conference is an opportunity for demonstrating possible means of
implementing the various components of the medical home. Conference
presentations are designed to provide exceptional group interaction,
discussion and evaluation to help formulate improved strategies. Also,
the conference provides wonderful networking opportunities through
special interest breakfasts, dine-outs and receptions.
Submit your valuable work online at www.stfm.org/pic. Submissions
directed to nurses, medical assistants, dietitians, coordinators, and
patient educators are welcomed. Submissions are encouraged at both
basic and advanced levels. Presentations should be designed to provide
practical advice and resources for both private practice and teaching
programs. Submissions will be evaluated for applicability to real world
settings. Works in progress are encouraged as long as they provide take
home lessons for attendees.
If you have any questions or need additional information, please
contact Dianna Azbill at STFM at 800-274-7928, ext. 5415 or
dazbill@stfm.org.
This is an exciting time in health care, and we look forward to
receiving and reviewing your submissions for presentation at the 2010
Conference in San Antonio!
Roger Shewmake, PhD, LN
2010 Conference Chair
This article gave some insight. It was found in JAMA about the elderly. It has an excellent review on dealing with the frail elderly. HERE
This shows the life expectancy of older patients. HERE
There are some excellent tables on screening questions and suggestions. The accompaning commentary showed what prevention services Medicare provide <<Medicare.pdf>>
Finally the third article was useful in that it gave a rational approach to making decisions in the elderly about mammography.
HERE
*Conference on Practice Improvement: Assembling the Patient-centered
Team*
December 2-5, 2010 * San Antonio, Texas
Conference Web site: http://www.stfm.org/pic
Submission Deadline: March 15, 2010
In our progress in building the Medical Home at the 2009 Practice
Improvement Conference, an important theme surfaced: the need for
improved patient-centered care and the value of the well coordinated
multidisciplinary team.
The time constraints of modern medical care demand an evidence based
team effort that divides the workload in a manner that utilizes the
strengths of various team members to provide accurate, efficient, and
timely care of the patient. This can only be successful through
appropriate training and experiences which assure the involvement of
patients and their families in active planning of their own care.
The Conference on Practice Improvement is designed to continue the
process of illustrating the development of the medical home model. The
conference is an opportunity for demonstrating possible means of
implementing the various components of the medical home. Conference
presentations are designed to provide exceptional group interaction,
discussion and evaluation to help formulate improved strategies. Also,
the conference provides wonderful networking opportunities through
special interest breakfasts, dine-outs and receptions.
Submit your valuable work online at www.stfm.org/pic. Submissions
directed to nurses, medical assistants, dietitians, coordinators, and
patient educators are welcomed. Submissions are encouraged at both
basic and advanced levels. Presentations should be designed to provide
practical advice and resources for both private practice and teaching
programs. Submissions will be evaluated for applicability to real world
settings. Works in progress are encouraged as long as they provide take
home lessons for attendees.
If you have any questions or need additional information, please
contact Dianna Azbill at STFM at 800-274-7928, ext. 5415 or
dazbill@stfm.org.
This is an exciting time in health care, and we look forward to
receiving and reviewing your submissions for presentation at the 2010
Conference in San Antonio!
Roger Shewmake, PhD, LN
2010 Conference Chair
Springboard message from Dr. Bachman
The Article today is on Jet Lag: HERE
There are three treatment strategies for jet lag that are conceptually distinct but that can be combined in practice. These include promoting a realignment of the circadian clock with the use of appropriately timed exposure to light, the administration of melatonin, or both; planning the optimal duration and timing of sleep; and using medication to counteract the symptoms of insomnia or daytime sleepiness.
For teaching, this POWERPoint will save you a lot of time It shows the digital library and a set of templates for games …. HERE
There are three treatment strategies for jet lag that are conceptually distinct but that can be combined in practice. These include promoting a realignment of the circadian clock with the use of appropriately timed exposure to light, the administration of melatonin, or both; planning the optimal duration and timing of sleep; and using medication to counteract the symptoms of insomnia or daytime sleepiness.
For teaching, this POWERPoint will save you a lot of time It shows the digital library and a set of templates for games …. HERE
Springboard message from Dr. Bachman
I've just returned from Honduras after spending time with 12 medical students and 10 other students on a selective. We saw patients, did education, pulled teeth, and provided an experience which was very good. If you are interested in this selective, we are going again next February. The Selective time was Feb 14-28 and included the 8 day trip in Honduras.
Along the way we saw plenty of scabies The NEJM had a nice article on this here
The Cochrane review also concluded that oral ivermectin appeared to be more effective than both lindane and topical benzyl benzoate (relative risk of treatment failure with ivermectin as compared with lindane, 0.36 in two trials involving 193 subjects, and relative risk with ivermectin as compared with benzyl benzoate, 0.50 in three trials involving 192 subjects). However, a recent study showed that there was a higher rate of treatment failure with single-dose ivermectin than with topical benzyl benzoate.19 This finding may reflect the fact that ivermectin does not sterilize scabies eggs. Therefore, a second dose of ivermectin is usually administered at least 1 week after the first dose to kill the newly hatched mites. Further support for this concept comes from a trial that compared ivermectin with topical permethrin in 85 patients. In that trial, a single dose of ivermectin was less effective than topical permethrin (cure rate of 70% vs. 98%), but if a second dose of ivermectin was administered to patients who did not have a response after the first dose, the cure rate with ivermectin rose to 95%
In the United States, the average wholesale price of a 60-g tube of 5% permethrin cream is approximately $30. The cost of a 3-mg tablet of ivermectin is approximately $6, which translates into a cost of about $30 for a single dose for a patient weighing 70 kg.
Meetings:
http://www.stfm.org/conferences/practiceimprovement/pi/index.cfm Has Conference for Practice Improvement. You have 12 days before the deadline fro submission. It is in San Antonio, Dec 2-5.
Unfortunately the Institute for Healthcare Improvement is meeting is close to the same time, Dec 5-8 in Orlando.
http://www.ihi.org/IHI/Programs/ConferencesAndSeminars/22ndAnnualNationalForumonQualityImprovementinHealthCare.htm
Both are excellent.
Have a good day
Along the way we saw plenty of scabies The NEJM had a nice article on this here
The Cochrane review also concluded that oral ivermectin appeared to be more effective than both lindane and topical benzyl benzoate (relative risk of treatment failure with ivermectin as compared with lindane, 0.36 in two trials involving 193 subjects, and relative risk with ivermectin as compared with benzyl benzoate, 0.50 in three trials involving 192 subjects). However, a recent study showed that there was a higher rate of treatment failure with single-dose ivermectin than with topical benzyl benzoate.19 This finding may reflect the fact that ivermectin does not sterilize scabies eggs. Therefore, a second dose of ivermectin is usually administered at least 1 week after the first dose to kill the newly hatched mites. Further support for this concept comes from a trial that compared ivermectin with topical permethrin in 85 patients. In that trial, a single dose of ivermectin was less effective than topical permethrin (cure rate of 70% vs. 98%), but if a second dose of ivermectin was administered to patients who did not have a response after the first dose, the cure rate with ivermectin rose to 95%
In the United States, the average wholesale price of a 60-g tube of 5% permethrin cream is approximately $30. The cost of a 3-mg tablet of ivermectin is approximately $6, which translates into a cost of about $30 for a single dose for a patient weighing 70 kg.
Meetings:
http://www.stfm.org/conferences/practiceimprovement/pi/index.cfm Has Conference for Practice Improvement. You have 12 days before the deadline fro submission. It is in San Antonio, Dec 2-5.
Unfortunately the Institute for Healthcare Improvement is meeting is close to the same time, Dec 5-8 in Orlando.
http://www.ihi.org/IHI/Programs/ConferencesAndSeminars/22ndAnnualNationalForumonQualityImprovementinHealthCare.htm
Both are excellent.
Have a good day
Saturday, March 20, 2010
Announcement
I just wanted to pass this along:
Meghna has two publications that have been accepted for publication in Evidence Based Practice:
1. What is the most effective non-pharmacologic treatment of anxiety symptoms in the institutionalized elderly patient? (May 2010)
2. What is the most effective pharmacologic treatment of anxiety symptoms in the institutionalized elderly patient? (June 2010)
This is now a peer-reviewed process. If you have any questions about writing these articles I'm sure Meghna, Alex, and Sara (am I forgetting someone else?) would be happy to share their experiences.
Congratulations, Meghna!
ps:
and so... If you are doing research and you haven't received some sort of mentorship (or maybe even acknowledgement) let me know so you can be recognized for your hard work.
Wednesday, March 17, 2010
job well done!
As I was driving in today, I couldn't help but notice what a robust gauntlet of pet grooming and fitness establishments exists in Kasson, Minnesota.
I thought to myself, "Bravo Kasson, Minnesota for raising the bar on pet and personal care"
I thought to myself, "Bravo Kasson, Minnesota for raising the bar on pet and personal care"
Tuesday, March 16, 2010
General exam link
From Dr. Meier:
I have been using this stuff for giving patients exercise and diet recs in a second while doing GME's, they seem to like it!
Thursday, March 11, 2010
social bookmarking
One good site I've been using in the past is www.delicious.com. It has the benefit of being able to save bookmarks in the cloud rather than just on one computer.
I use the Google Chrome browser and it is possible to set that up so that all bookmarks you save on that browser are saved in the cloud, as well. It's nice because you can see your bookmarks on docs.google.com
Monday, March 1, 2010
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