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Showing 1 - 200 of 3562 Journals sorted alphabetically
16 de Abril     Open Access  
AADE in Practice     Hybrid Journal   (Followers: 4)
ABCS Health Sciences     Open Access   (Followers: 1)
Abia State University Medical Students' Association Journal     Full-text available via subscription  
ACIMED     Open Access   (Followers: 1)
ACS Medicinal Chemistry Letters     Full-text available via subscription   (Followers: 39)
Acta Bio Medica     Full-text available via subscription   (Followers: 2)
Acta Bioethica     Open Access   (Followers: 1)
Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
Acta Facultatis Medicae Naissensis     Open Access  
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Medica Bulgarica     Open Access  
Acta Medica Colombiana     Open Access   (Followers: 1)
Acta Médica Costarricense     Open Access   (Followers: 2)
Acta Medica Indonesiana     Open Access  
Acta medica Lituanica     Open Access  
Acta Medica Marisiensis     Open Access  
Acta Medica Martiniana     Open Access  
Acta Medica Nagasakiensia     Open Access  
Acta Medica Peruana     Open Access   (Followers: 2)
Acta Médica Portuguesa     Open Access  
Acta Medica Saliniana     Open Access  
Acta Scientiarum. Health Sciences     Open Access  
Acupuncture & Electro-Therapeutics Research     Full-text available via subscription   (Followers: 2)
Addiction Science & Clinical Practice     Open Access   (Followers: 7)
Addictive Behaviors Reports     Open Access   (Followers: 6)
Advanced Health Care Technologies     Open Access   (Followers: 4)
Advanced Science, Engineering and Medicine     Partially Free   (Followers: 7)
Advances in Bioscience and Clinical Medicine     Open Access   (Followers: 5)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29)
Advances in Life Course Research     Hybrid Journal   (Followers: 8)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Medical Education and Practice     Open Access   (Followers: 26)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Medicine     Open Access   (Followers: 2)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4)
Advances in Molecular Oncology     Open Access   (Followers: 1)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 8)
Advances in Parkinson's Disease     Open Access  
Advances in Phytomedicine     Full-text available via subscription  
Advances in Preventive Medicine     Open Access   (Followers: 6)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20)
Advances in Therapy     Hybrid Journal   (Followers: 5)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5)
Advances in Wound Care     Hybrid Journal   (Followers: 10)
African Health Sciences     Open Access   (Followers: 2)
African Journal of Biomedical Research     Open Access  
African Journal of Clinical and Experimental Microbiology     Open Access   (Followers: 1)
African Journal of Laboratory Medicine     Open Access   (Followers: 2)
African Journal of Medical and Health Sciences     Open Access   (Followers: 2)
African Journal of Trauma     Open Access  
Afrimedic Journal     Open Access   (Followers: 2)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
AIDS Research and Human Retroviruses     Hybrid Journal   (Followers: 8)
AJOB Primary Research     Partially Free   (Followers: 3)
Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 4)
Al-Azhar Assiut Medical Journal     Open Access  
Alexandria Journal of Medicine     Open Access   (Followers: 1)
Allgemeine Homöopathische Zeitung     Hybrid Journal   (Followers: 2)
Alpha Omegan     Full-text available via subscription  
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 3)
American Journal of Biomedical Engineering     Open Access   (Followers: 11)
American Journal of Biomedical Research     Open Access   (Followers: 2)
American Journal of Biomedicine     Full-text available via subscription   (Followers: 6)
American Journal of Chinese Medicine, The     Hybrid Journal   (Followers: 5)
American Journal of Clinical Medicine Research     Open Access   (Followers: 5)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Law & Medicine     Full-text available via subscription   (Followers: 12)
American Journal of Lifestyle Medicine     Hybrid Journal   (Followers: 5)
American Journal of Managed Care     Full-text available via subscription   (Followers: 11)
American Journal of Medical Case Reports     Open Access   (Followers: 1)
American Journal of Medical Sciences and Medicine     Open Access   (Followers: 1)
American Journal of Medicine     Hybrid Journal   (Followers: 46)
American Journal of Medicine and Medical Sciences     Open Access   (Followers: 1)
American Journal of Medicine Studies     Open Access  
American Journal of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American Journal of the Medical Sciences     Hybrid Journal   (Followers: 12)
American Journal on Addictions     Hybrid Journal   (Followers: 9)
American Medical Journal     Open Access   (Followers: 4)
American medical news     Free   (Followers: 3)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Amyloid: The Journal of Protein Folding Disorders     Hybrid Journal   (Followers: 4)
Anales de la Facultad de Medicina     Open Access  
Anales de la Facultad de Medicina, Universidad de la República, Uruguay     Open Access  
Anales del Sistema Sanitario de Navarra     Open Access   (Followers: 1)
Analgesia & Resuscitation : Current Research     Hybrid Journal   (Followers: 3)
Anatomical Science International     Hybrid Journal   (Followers: 2)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1)
Anatomy Research International     Open Access   (Followers: 2)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3)
Annales de Pathologie     Full-text available via subscription  
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale     Full-text available via subscription   (Followers: 3)
Annals of African Medicine     Open Access   (Followers: 1)
Annals of Anatomy - Anatomischer Anzeiger     Hybrid Journal   (Followers: 2)
Annals of Bioanthropology     Open Access   (Followers: 3)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 18)
Annals of Biomedical Sciences     Full-text available via subscription   (Followers: 3)
Annals of Clinical Microbiology and Antimicrobials     Open Access   (Followers: 8)
Annals of Family Medicine     Open Access   (Followers: 13)
Annals of Fundeni Hospital     Open Access   (Followers: 1)
Annals of Ibadan Postgraduate Medicine     Open Access  
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Medicine     Hybrid Journal   (Followers: 12)
Annals of Medicine and Surgery     Open Access   (Followers: 5)
Annals of Microbiology     Hybrid Journal   (Followers: 10)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Saudi Medicine     Open Access  
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5)
Annals of The Royal College of Surgeons of England     Full-text available via subscription   (Followers: 3)
Annual Reports in Medicinal Chemistry     Full-text available via subscription   (Followers: 7)
Annual Reports on NMR Spectroscopy     Full-text available via subscription   (Followers: 4)
Annual Review of Medicine     Full-text available via subscription   (Followers: 18)
Anthropological Review     Open Access   (Followers: 24)
Anthropologie et santé     Open Access   (Followers: 5)
Antibiotics     Open Access   (Followers: 9)
Antibodies     Open Access   (Followers: 2)
Antibody Technology Journal     Open Access   (Followers: 1)
Anuradhapura Medical Journal     Open Access  
Anwer Khan Modern Medical College Journal     Open Access   (Followers: 2)
Apmis     Hybrid Journal   (Followers: 1)
Apparence(s)     Open Access   (Followers: 1)
Applied Clinical Informatics     Hybrid Journal   (Followers: 2)
Applied Medical Informatics     Open Access   (Followers: 11)
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Arak Medical University Journal     Open Access  
Archive of Clinical Medicine     Open Access   (Followers: 1)
Archive of Community Health     Open Access  
Archives of Biomedical Sciences     Open Access   (Followers: 7)
Archives of Medical and Biomedical Research     Open Access   (Followers: 3)
Archives of Medical Laboratory Sciences     Open Access   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Archives of Trauma Research     Open Access   (Followers: 2)
Archivos de Medicina (Manizales)     Open Access  
ArgoSpine News & Journal     Hybrid Journal  
Arquivos Brasileiros de Oftalmologia     Open Access  
Arquivos de Ciências da Saúde     Open Access  
Arquivos de Medicina     Open Access  
ARS Medica Tomitana     Open Access   (Followers: 1)
Art Therapy: Journal of the American Art Therapy Association     Full-text available via subscription   (Followers: 10)
Arterial Hypertension     Open Access  
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 12)
Artificial Organs     Hybrid Journal   (Followers: 1)
Asia Pacific Family Medicine     Open Access  
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 9)
Asia Pacific Journal of Clinical Trials : Nervous System Diseases     Open Access  
Asian Bioethics Review     Full-text available via subscription   (Followers: 2)
Asian Journal of Cell Biology     Open Access   (Followers: 6)
Asian Journal of Health     Open Access   (Followers: 3)
Asian Journal of Medical and Biological Research     Open Access   (Followers: 2)
Asian Journal of Medical and Pharmaceutical Researches     Open Access   (Followers: 1)
Asian Journal of Medical Sciences     Open Access   (Followers: 1)
Asian Journal of Scientific Research     Open Access   (Followers: 2)
Asian Journal of Transfusion Science     Open Access   (Followers: 2)
Asian Medicine     Hybrid Journal   (Followers: 4)
ASPIRATOR : Journal of Vector-borne Disease Studies     Open Access  
Astrocyte     Open Access  
Atención Familiar     Open Access  
Atención Primaria     Open Access   (Followers: 1)
Audiology - Communication Research     Open Access   (Followers: 8)
Auris Nasus Larynx     Full-text available via subscription  
Australian Coeliac     Full-text available via subscription   (Followers: 2)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Journal of Medical Science     Full-text available via subscription   (Followers: 1)
Autopsy and Case Reports     Open Access  
Aviation, Space, and Environmental Medicine     Full-text available via subscription   (Followers: 10)
Avicenna     Open Access   (Followers: 2)
Avicenna Journal of Medicine     Open Access   (Followers: 1)
Bangabandhu Sheikh Mujib Medical University Journal     Open Access   (Followers: 1)
Bangladesh Journal of Anatomy     Open Access   (Followers: 1)
Bangladesh Journal of Bioethics     Open Access  
Bangladesh Journal of Medical Biochemistry     Open Access   (Followers: 3)
Bangladesh Journal of Medical Education     Open Access   (Followers: 2)
Bangladesh Journal of Medical Microbiology     Open Access   (Followers: 3)
Bangladesh Journal of Medical Physics     Open Access  
Bangladesh Journal of Medical Science     Open Access  
Bangladesh Journal of Medicine     Open Access   (Followers: 1)
Bangladesh Journal of Physiology and Pharmacology     Open Access  
Bangladesh Journal of Scientific Research     Open Access   (Followers: 2)
Bangladesh Medical Journal     Open Access  
Bangladesh Medical Journal Khulna     Open Access  
Bangladesh Medical Research Council Bulletin     Open Access  
Basal Ganglia     Hybrid Journal  
Basic Sciences of Medicine     Open Access   (Followers: 2)
BBA Clinical     Open Access  
BC Medical Journal     Free  
Benha Medical Journal     Open Access  
Bijblijven     Hybrid Journal  
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Bio-Algorithms and Med-Systems     Hybrid Journal   (Followers: 1)
BioDiscovery     Open Access   (Followers: 2)
Bioelectromagnetics     Hybrid Journal   (Followers: 1)
Bioengineering & Translational Medicine     Open Access  
Bioethics     Hybrid Journal   (Followers: 14)
Bioethics Research Notes     Full-text available via subscription   (Followers: 14)
Biologics in Therapy     Open Access  
Biology of Sex Differences     Open Access   (Followers: 3)

        1 2 3 4 5 6 7 8 | Last

Journal Cover Annals of Family Medicine
  [SJR: 3.311]   [H-I: 78]   [13 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 1544-1709 - ISSN (Online) 1544-1717
   Published by Annals of Family Medicine Homepage  [1 journal]
  • Auscultation While Standing [article-commentary]

    • Authors: Johansen, M. E; Wu, S. N.
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2167
      Issue No: Vol. 15, No. 6 (2017)
  • In This Issue: Tech, Touch, & Templates for Understanding and Improving
           Care [Editorials]

    • Authors: Stange K. C.
      Pages: 502 - 503
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2158
      Issue No: Vol. 15, No. 6 (2017)
  • CORRECTION [Correction]

    • Pages: 503 - 503
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2168
      Issue No: Vol. 15, No. 6 (2017)
  • Reflections From a Statistical Editor: Elements of Great Manuscripts

    • Authors: Marino M.
      Pages: 504 - 506
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2157
      Issue No: Vol. 15, No. 6 (2017)
  • Randomized Controlled Trial of Text Message Reminders for Increasing
           Influenza Vaccination [Original Research]

    • Authors: Regan, A. K; Bloomfield, L, Peters, I, Effler, P. V.
      Pages: 507 - 514
      Abstract: PURPOSESeasonal influenza vaccine is recommended and funded for groups at higher risk of serious infection, but uptake is suboptimal. We conducted a randomized controlled trial of short message service (SMS) reminders for influenza vaccination.METHODSSix weeks after seasonal influenza vaccinations began, we identified high-risk patients who had a mobile telephone number on record at 10 practices in Western Australia. Thirty-two percent of the selected patients had already been vaccinated in the current year and were ineligible. Of the remaining 12,354 eligible patients at each practice one-half were randomly assigned to receive a vaccination reminder by SMS (intervention) and the rest received no SMS (control). Approximately 3 months after the SMS was sent (the study period), vaccination data were extracted from the patients’ electronic medical records. Log-binomial regression models were used to calculate the relative risk (RR) of vaccination between the intervention and control group.RESULTSTwelve-percent (769 of 6,177) of the intervention group and 9% (548 of 6,177) of the control group were vaccinated during the study period, a 39% relative increase attributable to the SMS (RR = 1.39; 95% CI, 1.26–1.54). For every 29 SMSs sent, costing $3.48, 1 additional high-risk patient was immunized. The greatest effect was observed for children younger than 5 years, whose parents were more than twice as likely to have their child vaccinated if they received a SMS reminder (RR = 2.43; 95% CI, 1.79–3.29).CONCLUSIONWe found SMS reminders to be a modestly effective, low-cost means to increase seasonal influenza vaccine coverage among high-risk patients.
      Keywords: Acute illness, Prevention, Vulnerable populations, Quantitative methods, Health services, Access, Health informatics
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2120
      Issue No: Vol. 15, No. 6 (2017)
  • Continuity of Primary Care and Emergency Hospital Admissions Among Older
           Patients in England [Original Research]

    • Authors: Tammes, P; Purdy, S, Salisbury, C, MacKichan, F, Lasserson, D, Morris, R. W.
      Pages: 515 - 522
      Abstract: PURPOSESecondary health care services have been under considerable pressure in England as attendance rates increase, resulting in longer waiting times and greater demands on staff. This study’s aim was to examine the association between continuity of care and risk of emergency hospital admission among older adults.METHODSWe analyzed records from 10,000 patients aged 65 years and older in 2012 within 297 English general practices obtained from the Clinical Practice Research Datalink and linked with Hospital Episode Statistics. We used the Bice and Boxerman (BB) index and the appointed general practitioner index (last general practitioner consulted before hospitalization) to quantify patient-physician continuity. The BB index was used in a prospective cohort approach to assess impact of continuity on risk of admission. Both indices were used in a separate retrospective nested case-control approach to test the effect of changing physician on the odds of hospital admission in the following 30 days.RESULTSIn the prospective cohort analysis, the BB index showed a graded, non-significant inverse relationship of continuity of care with risk of emergency hospital admission, although the hazard ratio for patients experiencing least continuity was 2.27 (95% CI, 1.37–3.76) compared with those having complete continuity. In the retrospective nested case-control analysis, we found a graded inverse relationship between continuity of care and emergency hospital admission for both BB and appointed general practitioner indices: for the latter, the odds ratio for those experiencing least continuity was 2.32 (95% CI, 1.48–3.63) relative to those experiencing most continuity.CONCLUSIONSMarked discontinuity of care might contribute to increased unplanned hospital admissions among patients aged 65 years and older. Schemes to enhance continuity of care have the potential to reduce hospital admissions.
      Keywords: Quantitative methods, Health policy, Health services, Continuity
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2136
      Issue No: Vol. 15, No. 6 (2017)
  • Auscultation While Standing: A Basic and Reliable Method to Rule Out a
           Pathologic Heart Murmur in Children [Original Research]

    • Authors: Lefort, B; Cheyssac, E, Soule, N, Poinsot, J, Vaillant, M.-C, Nassimi, A, Chantepie, A.
      Pages: 523 - 528
      Abstract: PURPOSEThe distinction between physiologic (innocent) and pathologic (organic) heart murmurs is not always easy in routine practice, leading too often to unnecessary cardiology referrals and expensive investigations. We aimed to test the hypothesis that the complete disappearance of murmur on standing can exclude cardiac disease in children.METHODSFrom January 2014 to January 2015, we prospectively included 194 consecutive children aged 2 to 18 years who were referred for heart murmur evaluation to pediatric cardiologists at 2 French medical centers. Heart murmur characteristics while supine and then while standing were recorded, and an echo-cardiogram was performed.RESULTSOverall, 30 (15%) of the 194 children had a pathologic heart murmur as determined by an abnormal echocardiogram. Among the 100 children (51%) who had a murmur that was present while they were supine but completely disappeared when they stood up, only 2 had a pathologic murmur, and just 1 of them needed further evaluation. Complete disappearance of the heart murmur on standing therefore excluded a pathologic murmur with a high positive predictive value of 98% and specificity of 93%, albeit with a lower sensitivity of 60%.CONCLUSIONSDisappearance of a heart murmur on standing is a reliable clinical tool for ruling out pathologic heart murmurs in children aged 2 years and older. This basic clinical assessment would avoid many unnecessary referrals to cardiologists.
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2105
      Issue No: Vol. 15, No. 6 (2017)
  • Exploring Attributes of High-Value Primary Care [Original Research]

    • Authors: Simon, M; Choudhry, N. K, Frankfort, J, Margolius, D, Murphy, J, Paita, L, Wang, T, Milstein, A.
      Pages: 529 - 534
      Abstract: PURPOSEMedicare’s merit-based incentive payment system and narrowing of physician networks by health insurers will stoke clinicians’ and policy makers’ interest in care delivery attributes associated with value as defined by payers.METHODSTo help define these attributes, we analyzed 2009 to 2011 commercial health insurance claims data for more than 40 million preferred provider organization patients attributed to over 53,000 primary care practice sites. We identified sites ranking favorably on both quality and low total annual per capita health care spending ("high-value") and sites ranking near the median ("average-value"). Sites were selected for qualitative assessment from 64 high-value sites and 102 average-value sites with more than 1 primary care physician who delivered adult primary care and provided services to enough enrollees to permit meaningful spending and quality ranking. Purposeful sampling ensured regional diversity. Physicians experienced in primary care assessment and blinded to site rankings visited 12 high-value sites and 4 average-value sites to identify tangible attributes of care delivery that could plausibly explain a high ranking on value.RESULTSThirteen attributes of care delivery distinguished sites in the high-value cohort. Six attributes attained statistical significance: decision support for evidence-based medicine, risk-stratified care management, careful selection of specialists, coordination of care, standing orders and protocols, and balanced physician compensation.CONCLUSIONSAwareness of care delivery attributes that distinguish their high-value peers may help physicians respond successfully to incentives from Medicare and private payers to lower annual health care spending and improve quality of care.
      Keywords: Chronic illness, Quantitative methods, Health policy, Health services, Access, Continuity, Comprehensiveness, Coordination / integration of care, Quality improvement
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2153
      Issue No: Vol. 15, No. 6 (2017)
  • General Practitioner-Performed Compression Ultrasonography for Diagnosis
           of Deep Vein Thrombosis of the Leg: A Multicenter, Prospective Cohort
           Study [Original Research]

    • Authors: Mumoli, N; Vitale, J, Giorgi-Pierfranceschi, M, Sabatini, S, Tulino, R, Cei, M, Bucherini, E, Bova, C, Mastroiacovo, D, Camaiti, A, Palmiero, G, Puccetti, L, Dentali, F, for the PRACTICUS Study Investigators
      Pages: 535 - 539
      Abstract: BACKGROUNDPatients with suspected deep vein thrombosis (DVT) of the lower limb represent a diagnostic dilemma for general practitioners. Compression ultrasonography (US) is universally recognized as the best test of choice. We assessed the diagnostic accuracy of compression US performed by general practitioners given short training in the management of symptomatic proximal DVT.METHODSFrom May 2014 to May 2016, we evaluated in a multicenter, prospective cohort study all consecutive outpatients with suspected DVT; bilateral proximal lower limb compression US was performed by general practitioners and by physicians expert in vascular US, each group blinded to the other’s findings. In all examinations with a negative or nondiagnostic result, compression US was repeated by the same operator after 5 to 7 days. Inter-observer agreement and accuracy were calculated.RESULTSWe enrolled a total of 1,107 patients. The expert physicians diagnosed DVT in 200 patients, corresponding to an overall prevalence of 18.1% (95% CI, 15.8%–20.3%). The agreement between the trained general practitioners and the experts was excellent (Cohen = 0.86; 95% CI, 0.84–0.88). Compression US performed by general practitioners had a sensitivity of 90.0% (95% CI, 88.2%–91.8%) and a specificity of 97.1% (95% CI, 96.2%–98.1%) with a diagnostic accuracy for DVT of 95.8% (95% CI, 94.7%–97.0%).CONCLUSIONSOur results suggest that, even in hands of physicians not expert in vascular US, compression US can be a reliable tool in the diagnosis of DVT. We found that the sensitivity achieved by general practitioners appeared suboptimal, however, so future studies should evaluate the implementation of proper training strategies to maximize skill.
      Keywords: Acute illness, Quantitative methods, Health services, Professional practice, Access, Comprehensiveness
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2109
      Issue No: Vol. 15, No. 6 (2017)
  • An Autoethnographic Examination of Postpartum Depression [Original

    • Authors: Frankhouser, T. L; Defenbaugh, N. L.
      Pages: 540 - 545
      Abstract: PURPOSEThis article examines postpartum depression (PPD) using autoethnography to explore the stigmatization of depression and cultural expectations of motherhood. Because the personal experiences of living with PPD are often absent from primary care literature, this article uses first-person narrative and analysis of intensive mothering to explore the barriers to seeking PPD treatment, the need for increasing physician confidence and comfort using screening tools, and the impact PPD stigma has on patients and their health care.METHODSAutoethnography, as a relatively unfamiliar methodology in primary care, is used to illuminate individual experiences of living with PPD. The author details a series of encounters as wife, mother, and patient by narrating what it means to live with the disease. A thematic analysis of the series of first-person narratives was employed to further understand the culture of motherhood and shed light on the stigmatization of PPD.RESULTSFour themes emerged from the analysis revealing the pressures surrounding the cultural ideologies of intensive mothering and the stigma of mental illness: essentialism, failure, shame, and avoidance.DISCUSSIONThere is a need to reframe cultural perceptions of motherhood and PPD to positively impact familial interactions and health care encounters for those who live with the illness. The article calls for providing broader diagnostic efforts, more comprehensive care, and engagement with patients in shared decision making around the diagnosis and treatment of PPD.
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2107
      Issue No: Vol. 15, No. 6 (2017)
  • Multimorbidity and Decision-Making Preferences Among Older Adults
           [Original Research]

    • Authors: Chi, W. C; Wolff, J, Greer, R, Dy, S.
      Pages: 546 - 551
      Abstract: PURPOSEUnderstanding individuals’ preferences for participating in health care decisions is foundational to delivering person-centered care. We aimed to (1) explore preferences for health care decision making among older adults, and (2) identify multimorbidity profiles associated with preferring less active, ie, passive, participation among older US adults.METHODOurs was a cross-sectional, nationally representative study of 2,017 National Health and Aging Trends Study respondents. Passive decision-making preference was defined as preferring to leave decisions to physicians. Multimorbidity profiles, based on 13 prevalent chronic conditions, were examined as (1) presence of 2 or more conditions, (2) a simple conditions count, and (3) a condition clusters count. Multiple logistic regression was used with adjustment for age, sex, education, English proficiency, and mobility limitation.RESULTSMost older adults preferred to participate actively in making health care decisions. Older adults with 4 or more conditions, however, and those with multiple condition clusters are relatively less likely to prefer active decision making.CONCLUSIONSPrimary care physicians should initiate a shared decision-making process with older adults with 4 or more conditions or multiple condition clusters. Physicians should anticipate variation in decision-making preferences among older adults and adapt a decision-making process that suits individuals’ preferences for participation to ensure person-centered care delivery.
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2106
      Issue No: Vol. 15, No. 6 (2017)
  • Trends in Patient-Perceived Shared Decision Making Among Adults in the
           United States, 2002-2014 [Research Briefs]

    • Authors: Levine, D. M; Landon, B. E, Linder, J. A.
      Pages: 552 - 556
      Abstract: To ascertain changes in shared decision making (SDM), we analyzed data from the nationally representative Medical Expenditure Panel Survey. We aggregated responses to questions into a 7-point SDM composite score. Between 2002 and 2014, the mean SDM composite score increased from 4.4 to 5.0 (P
      Keywords: Chronic illness, Vulnerable populations, Quantitative methods, Health services, Relationship, Communication / decision making, Disparities in health and health care
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2132
      Issue No: Vol. 15, No. 6 (2017)
  • Factors Influencing Allopurinol Initiation in Primary Care [Research

    • Authors: Clarson, L. E; Hider, S. L, Belcher, J, Roddy, E, Mallen, C. D.
      Pages: 557 - 560
      Abstract: Despite guidance on appropriate initiation, urate-lowering therapy is prescribed for only a minority of patients with gout. Electronic health records for 8,142 patients with gout were used to investigate the effect of age, sex, comorbidities, number of consultations, and meeting internationally agreed eligibility criteria on time to allopurinol initiation. Time to first prescription was modeled using multilevel Cox proportional hazards regression. Allopurinol initiation was positively associated with meeting eligibility criteria at diagnosis of gout, but negatively associated with becoming eligible after diagnosis. Managing gout as a chronic disease, with regular reviews to discuss allopurinol treatment, may reduce barriers to treatment.
      Keywords: Acute illness, Chronic illness, Older adults
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2137
      Issue No: Vol. 15, No. 6 (2017)
  • Comparative Associations Between Measures of Anti-cholinergic Burden and
           Adverse Clinical Outcomes [Methodology]

    • Authors: Hsu, W.-H; Wen, Y.-W, Chen, L.-K, Hsiao, F.-Y.
      Pages: 561 - 569
      Abstract: PURPOSENo consensus has been reached regarding which anticholinergic scoring system works most effectively in clinical settings. The aim of this population-based cohort study was to examine the association between anticholinergic medication burden, as defined by different scales, and adverse clinical outcomes among older adults.METHODSFrom Taiwan’s Longitudinal Health Insurance Database, we retrieved data on monthly anticholinergic drug use measured by the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden Scale (ACB), and the Drug Burden Index - Anticholinergic component (DBI-Ach) for 116,043 people aged 65 years and older during a 10-year follow-up. For all 3 scales, a higher score indicates greater anticholinergic burden. We used generalized estimating equations to examine the association between anticholinergic burden (ARS and ACB: grouped from 0 to ≥4; DBI-Ach: grouped as 0, 0–0.5, and 0.5–1) and adverse outcomes, and stratified individuals by age-group (aged 65–74, 75–84, and ≥85 years).RESULTSCompared with the ARS and DBI-Ach, the ACB showed the strongest, most consistent dose-response relationships with risks of all 4 adverse outcomes, particularly in people aged 65 to 84 years. For example, among those 65 to 74 years old, going from an ACB score of 1 to a score of 4 or greater, individuals’ adjusted odds ratio increased from 1.41 to 2.25 for emergency department visits; from 1.32 to 1.92 for all-cause hospitalizations; from 1.10 to 1.71 for fracture-specific hospitalizations; and from 3.13 to 10.01 for incident dementia.CONCLUSIONSCompared with the 2 other scales studied, the ACB shows good dose-response relationships between anticholinergic burden and a variety of adverse outcomes in older adults. For primary care and geriatrics clinicians, the ACB may be a helpful tool for identifying high-risk populations for interventions.
      Keywords: Chronic illness, Disease pathophysiology / etiology, Older adults, Quantitative methods, Health services, Research capacity building
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2131
      Issue No: Vol. 15, No. 6 (2017)
  • The Foundations Framework for Developing and Reporting New Models of Care
           for Multimorbidity [Methodology]

    • Authors: Stokes, J; Man, M.-S, Guthrie, B, Mercer, S. W, Salisbury, C, Bower, P.
      Pages: 570 - 577
      Abstract: PURPOSEMultimorbidity challenges health systems globally. New models of care are urgently needed to better manage patients with multimorbidity; however, there is no agreed framework for designing and reporting models of care for multimorbidity and their evaluation.METHODSBased on findings from a literature search to identify models of care for multimorbidity, we developed a framework to describe these models. We illustrate the application of the framework by identifying the focus and gaps in current models of care, and by describing the evolution of models over time.RESULTSOur framework describes each model in terms of its theoretical basis and target population (the foundations of the model) and of the elements of care implemented to deliver the model. We categorized elements of care into 3 types: (1) clinical focus, (2) organization of care, (3) support for model delivery. Application of the framework identified a limited use of theory in model design and a strong focus on some patient groups (elderly, high users) more than others (younger patients, deprived populations). We found changes in elements with time, with a decrease in models implementing home care and an increase in models offering extended appointments.CONCLUSIONSBy encouragin greater clarity about the underpinning theory and target population, and by categorizing the wide range of potentially important elements of an intervention to improve care for patients with multimorbidity, the framework may be useful in designing and reporting models of care and help advance the currently limited evidence base.
      Keywords: Chronic illness, Older adults, Children's health, Vulnerable populations, Health services, Professional practice, Personalized care, Disparities in health and health care, Multimorbidity
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2150
      Issue No: Vol. 15, No. 6 (2017)
  • Caring for the Tribe: From Addiction to Zen [Reflections]

    • Authors: Loxterkamp D.
      Pages: 578 - 580
      Abstract: The culture of medicine is rapidly changing. The majority of primary care physicians are now employed, and the decisions that govern us are made farther and farther from the point of care. Our sense of well-being is threatened less by the demands of clinical practice than it is by the emptiness of our job: we have forgotten who we are working for, or working with, or why we are working at all. The solution lies in creating the kind of practice environment that we advocate for in each of our patients’ lives.
      Keywords: Mental health, Professional practice, Relationship, Social / cultural context
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2151
      Issue No: Vol. 15, No. 6 (2017)
  • Hatpins [Reflections]

    • Authors: Koplinka-Loehr I.
      Pages: 581 - 582
      Abstract: Hatpins is a first-person narrative that delves into a physician’s experience of a patient death during the early years of residency. The essay reflects on the conflicted physician-patient relationships that can develop even over the short tenure of residency. While residency seeks to create medically prepared and compassionate physicians, this piece speaks to the importance of the often subtle learning that comes from ethical, social, and cultural aspects of both the lives and deaths of our patients.
      Keywords: Personalized care, Relationship, Communication / decision making, Mindfulness and reflection, Social / cultural context
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2135
      Issue No: Vol. 15, No. 6 (2017)
  • How Health Systems Can Promote Healthier Eating [Innovations in Primary

    • Authors: Parsons, A; Spurrell-Huss, E, Lucan, S. C.
      Pages: 583 - 583
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2155
      Issue No: Vol. 15, No. 6 (2017)
  • Huddling Up: Expanding Clinic Huddles [Innovations in Primary Care]

    • Authors: Tseng A.
      Pages: 584 - 584
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2156
      Issue No: Vol. 15, No. 6 (2017)
           Medicine Updates]

    • Authors: Porter S.
      Pages: 585 - 586
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2161
      Issue No: Vol. 15, No. 6 (2017)
           Medicine Updates]

    • Authors: Ireland J.
      Pages: 586 - 588
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2162
      Issue No: Vol. 15, No. 6 (2017)

    • Authors: Brown Speights, J. S; Figueroa, E, Figueroa, E, Washington, J.
      Pages: 588 - 589
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2165
      Issue No: Vol. 15, No. 6 (2017)
           PROGRAMS [Family Medicine Updates]

    • Authors: Doubeni, C. A; Davis, A, Benson, J. L, Ewigman, B, on behalf of the ADFM Research Development Committee
      Pages: 589 - 590
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2160
      Issue No: Vol. 15, No. 6 (2017)
           Medicine Updates]

    • Authors: Mitchell, K. B; Miller, T.
      Pages: 591 - 591
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2163
      Issue No: Vol. 15, No. 6 (2017)

    • Authors: Haught J.
      Pages: 592 - 592
      PubDate: 2017-11-13T14:00:15-08:00
      DOI: 10.1370/afm.2164
      Issue No: Vol. 15, No. 6 (2017)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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Fax: +00 44 (0)131 4513327
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