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  Subjects -> MEDICAL SCIENCES (Total: 7439 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (197 journals)
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MEDICAL SCIENCES (1857 journals)                  1 2 3 4 5 6 7 8 | Last

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: 40)
Acta Bio Medica     Full-text available via subscription   (Followers: 2)
Acta Bioethica     Open Access  
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   (Followers: 1)
Acupuncture & Electro-Therapeutics Research     Full-text available via subscription   (Followers: 3)
Acupuncture and Natural Medicine     Open Access  
Addiction Science & Clinical Practice     Open Access   (Followers: 6)
Addictive Behaviors Reports     Open Access   (Followers: 7)
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: 28)
Advances in Life Course Research     Hybrid Journal   (Followers: 8)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Medical Education and Practice     Open Access   (Followers: 25)
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: 2)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7)
Advances in Parkinson's Disease     Open Access  
Advances in Phytomedicine     Full-text available via subscription  
Advances in Preventive Medicine     Open Access   (Followers: 5)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 18)
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)
AJSP: Reviews & Reports     Hybrid Journal  
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: 12)
American Journal of Biomedical Research     Open Access   (Followers: 2)
American Journal of Biomedicine     Full-text available via subscription   (Followers: 7)
American Journal of Chinese Medicine, The     Hybrid Journal   (Followers: 4)
American Journal of Clinical Medicine Research     Open Access   (Followers: 6)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Law & Medicine     Full-text available via subscription   (Followers: 10)
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: 3)
American Journal of Medicine     Hybrid Journal   (Followers: 42)
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: 7)
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: 5)
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: 4)
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)
Ankara Medical Journal     Open Access   (Followers: 2)
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: 4)
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: 9)
Annals of Family Medicine     Open Access   (Followers: 12)
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: 7)
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: 17)
Anthropological Review     Open Access   (Followers: 22)
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 Clinical Research, Clinical Trials and Regulatory Affairs     Hybrid Journal  
Applied Medical Informatics     Open Access   (Followers: 10)
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 : Revista de Ciencias Médicas     Open Access  
ARS Medica Tomitana     Open Access   (Followers: 1)
Art Therapy: Journal of the American Art Therapy Association     Full-text available via subscription   (Followers: 11)
Arterial Hypertension     Open Access   (Followers: 1)
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 12)
Artificial Organs     Hybrid Journal   (Followers: 1)
Asia Pacific Family Medicine     Open Access   (Followers: 1)
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 10)
Asia Pacific Journal of Clinical Trials : Nervous System Diseases     Open Access  
Asian Bioethics Review     Full-text available via subscription   (Followers: 3)
Asian Journal of Cell Biology     Open Access   (Followers: 5)
Asian Journal of Health     Open Access   (Followers: 3)
Asian Journal of Medical and Biological Research     Open Access   (Followers: 3)
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: 3)
Asian Journal of Transfusion Science     Open Access   (Followers: 1)
Asian Medicine     Hybrid Journal   (Followers: 5)
Asian Pacific Journal of Cancer Prevention     Open Access  
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: 1)
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: 3)
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: 1)
Bangladesh Medical Journal     Open Access  
Bangladesh Medical Journal Khulna     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  

        1 2 3 4 5 6 7 8 | Last

Journal Cover Annals of Family Medicine
  [SJR: 3.311]   [H-I: 78]   [12 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]
  • A Primary Care-Driven eConsult Service [article-commentary]

    • Authors: Murray, K. R; Johansen, M. E.
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2209
      Issue No: Vol. 16, No. 2 (2018)
       
  • In This Issue: Refining Care and its Frameworks [Editorials]

    • Authors: Stange K. C.
      Pages: 98 - 99
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2218
      Issue No: Vol. 16, No. 2 (2018)
       
  • Thank you, Reviewers and E-letter Contributors! [Editorials]

    • Pages: 99 - 99
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2225
      Issue No: Vol. 16, No. 2 (2018)
       
  • Use of Asthma APGAR Tools in Primary Care Practices: A Cluster-Randomized
           Controlled Trial [Original Research]

    • Authors: Yawn, B. P; Wollan, P. C, Rank, M. A, Bertram, S. L, Juhn, Y, Pace, W.
      Pages: 100 - 110
      Abstract: PURPOSEThe purpose of this study was to assess patient and practice outcomes after introducing the Asthma APGAR (Activities, Persistent, triGGers, Asthma medications, Response to therapy) tools into primary care practices.METHODSWe used a pragmatic cluster-randomized controlled design in 18 US family medicine and pediatric practices to compare outcomes in patients with persistent asthma aged 5 to 45 years after introduction of the Asthma APGAR tools vs usual care. Patient outcomes included asthma control, quality of life, and emergency department (ED), urgent care, and inpatient hospital visits. The practice outcome was adherence to asthma guidelines.RESULTSWe enrolled 1,066 patients: 245 children, 174 adolescents, and 647 adults. Sixty-five percent (692 patients) completed both baseline and 12-month questionnaires, allowing analysis for patient-reported outcomes. Electronic health record data were available for 1,063 patients (99.7%) for practice outcomes. The proportion of patients reporting an asthma-related ED, urgent care, or hospital visit in the final 6 months of the study was lower in the APGAR practices vs usual care practices (10.6% vs 20.9%, P = .004). The percentage of patients with "in control" asthma increased more between baseline and 1 year in the APGAR group vs usual care group (13.5% vs 3.4%, P =.0001 vs P =.86) with a trend toward better control scores and asthma-related quality of life in the former at 1 year (P ≤.06 and P = .06, respectively). APGAR practices improved their adherence to 3 or more guideline elements compared with usual care practices (20.7% increase vs 1.9% decrease, P = .001).CONCLUSIONSIntroduction of the Asthma APGAR tools improves rates of asthma control; reduces asthma-related ED, urgent care, and hospital visits; and increases practices’ adherence to asthma management guidelines.
      Keywords: Chronic illness, Children's health, Quantitative methods, Health services, Coordination / integration of care, Clinical practice guidelines, Quality improvement
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2179
      Issue No: Vol. 16, No. 2 (2018)
       
  • Treating Subthreshold Depression in Primary Care: A Randomized Controlled
           Trial of Behavioral Activation With Mindfulness [Original Research]

    • Authors: Wong, S. Y. S; Sun, Y. Y, Chan, A. T. Y, Leung, M. K. W, Chao, D. V. K, Li, C. C. K, Chan, K. K. H, Tang, W. K, Mazzucchelli, T, Au, A. M. L, Yip, B. H. K.
      Pages: 111 - 119
      Abstract: PURPOSEWe undertook a randomized controlled trial to assess the efficacy of group-based behavioral activation with mindfulness (BAM) for treating subthreshold depression in primary care in Hong Kong.METHODSWe recruited adult patients aged 18 years or older with subthreshold depression from public primary care clinics and randomly assigned them to a BAM intervention group or a usual care group. The BAM group was provided with eight 2-hour weekly BAM sessions by trained allied health care workers. Patients in the usual care group received usual medical care with no additional psychological interventions. The primary outcome was depressive symptoms measured by the Beck Depression Inventory-II at 12 months. Secondary outcomes included incidence of major depressive disorder at 12 months. We assessed quality of life, activity and circumstances change, functional impairment, and anxiety at baseline, end of intervention, 5 months, and 12 months.RESULTSWe randomly allocated 115 patients to the BAM intervention and 116 patients to usual care. At 12 months, compared with usual care peers, BAM patients had a slightly more favorable change in levels of depressive symptoms on the Beck Depression Inventory-II (between-group mean difference in score = –3.85; 95% CI, –6.36 to –1.34; Cohen d = –0.46, 95% CI, –0.76 to –0.16). Incidence of major depressive disorder was lower with BAM (10.8% vs 26.8%, P = .01), whereas groups did not differ significantly on other secondary outcomes at 12 months.CONCLUSIONSGroup BAM appears to be efficacious for decreasing depressive symptoms and reducing the incidence of major depression among patients with subthreshold depression in primary care, although generalizability of our findings may be limited.
      Keywords: Mental health, Quantitative methods
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2206
      Issue No: Vol. 16, No. 2 (2018)
       
  • Sustainability of a Primary Care-Driven eConsult Service [Original
           Research]

    • Authors: Liddy, C; Moroz, I, Afkham, A, Keely, E.
      Pages: 120 - 126
      Abstract: PURPOSEExcessive wait times for specialist appointments pose a serious barrier to patient care. To improve access to specialist care and reduce wait times, we launched the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service in April 2011. The objective of this study is to report on the impact of our multiple specialty eConsult service during the first 5 years of use after implementation, with a focus on growth and sustainability.METHODSWe conducted a cross-sectional study of all eConsult cases submitted between April 1, 2011 and April 30, 2016, and measured impact with system utilization data and mandatory close-out surveys completed at the end of each eConsult. Impact indicators included time interval to obtain specialist advice, effect of specialist advice on the primary care clinician’s course of action, and rate of avoidance of face-to-face visits.RESULTSA total of 14,105 eConsult cases were directed to 56 different medical specialty groups, completed with a median response time of 21 hours, and 65% of all eConsults were resolved without a specialist visit. We observed rapid growth in the use of eConsult during the study period: 5 years after implementation the system was in use by 1,020 primary care clinicians, with more than 700 consultations taking place per month.CONCLUSIONSThis study presents the first in-depth look at the growth and sustainability of the multispecialty eConsult service. The results show the positive impact of an eConsult service and can inform other regions interested in implementing similar systems.
      Keywords: Quantitative methods, Health services, Professional practice, Access, Coordination / integration of care, Communication / decision making, Quality improvement
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2177
      Issue No: Vol. 16, No. 2 (2018)
       
  • Multimorbidity and Socioeconomic Deprivation in Primary Care Consultations
           [Original Research]

    • Authors: Mercer, S. W; Zhou, Y, Humphris, G. M, McConnachie, A, Bakhshi, A, Bikker, A, Higgins, M, Little, P, Fitzpatrick, B, Watt, G. C. M.
      Pages: 127 - 131
      Abstract: PURPOSEThe influence of multimorbidity on the clinical encounter is poorly understood, especially in areas of high socioeconomic deprivation where burdensome multimorbidity is concentrated. The aim of the current study was to examine the effect of multimorbidity on general practice consultations, in areas of high and low deprivation.METHODSWe conducted secondary analyses of 659 video-recorded routine consultations involving 25 general practitioners (GPs) in deprived areas and 22 in affluent areas of Scotland. Patients rated the GP’s empathy using the Consultation and Relational Empathy (CARE) measure immediately after the consultation. Videos were analyzed using the Measure of Patient-Centered Communication. Multilevel, multi-regression analysis identified differences between the groups.RESULTSIn affluent areas, patients with multimorbidity received longer consultations than patients without multimorbidity (mean 12.8 minutes vs 9.3, respectively; P = .015), but this was not so in deprived areas (mean 9.9 minutes vs 10.0 respectively; P = .774). In affluent areas, patients with multimorbidity perceived their GP as more empathic (P = .009) than patients without multimorbidity; this difference was not found in deprived areas (P = .344). Video analysis showed that GPs in affluent areas were more attentive to the disease and illness experience in patients with multimorbidity (P < .031) compared with patients without multimorbidity. This was not the case in deprived areas (P = .727).CONCLUSIONSIn deprived areas, the greater need of patients with multimorbidity is not reflected in the longer consultation length, higher GP patient centeredness, and higher perceived GP empathy found in affluent areas. Action is required to redress this mismatch of need and service provision for patients with multimorbidity if health inequalities are to be narrowed rather than widened by primary care.
      Keywords: Chronic illness, Vulnerable populations, Quantitative methods, Health services, Professional practice, Access, Relationship, Disparities in health and health care, Multimorbidity
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2202
      Issue No: Vol. 16, No. 2 (2018)
       
  • A Core Outcome Set for Multimorbidity Research (COSmm) [Original Research]

    • Authors: Smith, S. M; Wallace, E, Salisbury, C, Sasseville, M, Bayliss, E, Fortin, M.
      Pages: 132 - 138
      Abstract: PURPOSEWe aimed to develop a consensus-based set of core outcomes specifically for studies in multimorbidity.METHODSWe undertook a consensus study following the COS-STAR (Core Outcome Set-STAndards for Reporting) guidelines for the design and reporting of core outcome sets. A Delphi panel of experts completed a web-based survey with 2 rounds. Panelists were presented with a range of outcomes that had been identified in previous workshops and a related systematic review. They indicated their level of agreement on whether each outcome should be included in the core set using a 5-point Likert scale, and outcomes reaching a prespecified consensus level were included.RESULTSOf 30 individuals invited to be panelists, 26 from 13 countries agreed. All 26 completed both rounds of the survey. The Delphi panel reached consensus on 17 outcomes for inclusion in a core outcome set for multimorbidity (COSmm). The highest-ranked outcomes were health-related quality of life, mental health outcomes, and mortality. Other outcomes were grouped into overarching themes of patient-reported impacts and behaviors (treatment burden, self-rated health, self-management behavior, self-efficacy, adherence); physical activity and function (activities of daily living, physical function, physical activity); consultation related (communication, shared decision making, prioritization); and health systems (health care use, costs, quality of health care).CONCLUSIONSThis consensus study involved a wide range of international experts who identified a large number of outcomes for multimorbidity intervention studies. Our results suggest that quality of life, mental health outcomes, and mortality should be regarded as essential core outcomes. Researchers should, however, also consider the full range of outcomes when designing studies to capture important domains in multimorbidity depending on individual study aims and interventions.
      Keywords: Chronic illness, Mental health, Older adults, Quantitative methods, Research capacity building, Multimorbidity
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2178
      Issue No: Vol. 16, No. 2 (2018)
       
  • Recent Patterns in Shared Decision Making for Prostate-Specific Antigen
           Testing in the United States [Original Research]

    • Authors: Fedewa, S. A; Gansler, T, Smith, R, Sauer, A. G, Wender, R, Brawley, O. W, Jemal, A.
      Pages: 139 - 144
      Abstract: PURPOSEPrevious studies report infrequent use of shared decision making for prostate-specific antigen (PSA) testing. It is unknown whether this pattern has changed recently considering increased emphasis on shared decision making in prostate cancer screening recommendations. Thus, the objective of this study is to examine recent changes in shared decision making.METHODSWe conducted a retrospective cross-sectional study among men aged 50 years and older in the United States using 2010 and 2015 National Health Interview Survey (NHIS) data (n = 9,598). Changes in receipt of shared decision making were expressed as adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Analyses were stratified on PSA testing (recent [in the past year] or no testing). Elements of shared decision making assessed included the patient being informed about the advantages only, advantages and disadvantages, and full shared decision making (advantages, disadvantages, and uncertainties).RESULTSAmong men with recent PSA testing, 58.5% and 62.6% reported having received ≥1 element of shared decision making in 2010 and 2015, respectively (P = .054, aPR = 1.04; 95% CI, 0.98–1.11). Between 2010 and 2015, being told only about the advantages of PSA testing significantly declined (aPR = 0.82; 95% CI, 0.71–0.96) and full shared decision making prevalence significantly increased (aPR = 1.51; 95% CI, 1.28–1.79) in recently tested men. Among men without prior PSA testing, 10% reported ≥1 element of shared decision making, which did not change with time.CONCLUSIONBetween 2010 and 2015, there was no increase in shared decision making among men with recent PSA testing though there was a shift away from only being told about the advantages of PSA testing towards full shared decision making. Many men receiving PSA testing did not receive shared decision making.
      Keywords: Prevention, Quantitative methods, Personalized care, Communication / decision making
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2200
      Issue No: Vol. 16, No. 2 (2018)
       
  • The Relationship Between Oseltamivir and Suicide in Pediatric Patients
           [Research Brief]

    • Authors: Harrington, R; Adimadhyam, S, Lee, T. A, Schumock, G. T, Antoon, J. W.
      Pages: 145 - 148
      Abstract: PURPOSEStudies examining the association between use of oseltamivir and neuropsychiatric events (including suicide) among children have had mixed findings and have been limited by small sample size, reliance on older data, and potential confounding. We undertook an analysis that addresses these limitations.METHODSUsing a national administrative claims database and a case-crossover design that minimized confounding, we analyzed data from 5 contemporary influenza seasons (2009–2013) for individuals aged 1 to 18 years and ascertained oseltamivir exposure from pharmacy dispensing.RESULTSWe identified 21,407 suicide-related events during this study period, 251 of which were in oseltamivir-exposed children. In case-crossover analysis, we did not find any significant association with suicide either for oseltamivir exposure (odds ratio = 0.64; 95% CI, 0.39–1.00; P = .05) or for influenza diagnosis alone (odds ratio = 0.63; 95% CI, 0.34–1.08; P = .10).CONCLUSIONOur findings suggest that oseltamivir does not increase risk of suicide in the pediatric population.
      Keywords: Acute illness, Mental health, Children's health, Quantitative methods
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2183
      Issue No: Vol. 16, No. 2 (2018)
       
  • Digital Rectal Examination for Prostate Cancer Screening in Primary Care:
           A Systematic Review and Meta-Analysis [Systematic Review]

    • Authors: Naji, L; Randhawa, H, Sohani, Z, Dennis, B, Lautenbach, D, Kavanagh, O, Bawor, M, Banfield, L, Profetto, J.
      Pages: 149 - 154
      Abstract: PURPOSEAlthough the digital rectal examination (DRE) is commonly performed to screen for prostate cancer, there is limited data to support its use in primary care. This review and meta-analysis aims to evaluate the diagnostic accuracy of DRE in screening for prostate cancer in primary care settings.METHODSWe searched MEDLINE, Embase, DARE (Database of s of Reviews of Effects), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) from their inception to June 2016. Six reviewers, in pairs, independently screened citations for eligibility and extracted data. Pooled estimates were calculated for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DRE in primary care settings using an inverse-variance meta-analysis. We used QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) and GRADE (Grades of Recommendation Assessment, Development, and Evaluation) guidelines to assess study risk of bias and quality.RESULTSOur search yielded 8,217 studies, of which 7 studies with 9,241 patients were included after the screening process. All patients analyzed underwent both DRE and biopsy. Pooled sensitivity of DRE performed by primary care clinicians was 0.51 (95% CI, 0.36–0.67; I2 = 98.4%) and pooled specificity was 0.59 (95% CI, 0.41–0.76; I2 = 99.4%). Pooled PPV was 0.41 (95% CI, 0.31–0.52; I2 = 97.2%), and pooled NPV was 0.64 (95% CI, 0.58–0.70; I2 = 95.0%). The quality of evidence as assessed with GRADE was very low.CONCLUSIONGiven the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting.
      Keywords: Prevention, Quantitative methods, Clinical practice guidelines
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2205
      Issue No: Vol. 16, No. 2 (2018)
       
  • Moving From Problem-Oriented to Goal-Directed Health Records [Special
           Report]

    • Authors: Nagykaldi, Z. J; Tange, H, De Maeseneer, J.
      Pages: 155 - 159
      Abstract: Electronic health records (EHRs) have been in place for decades; however, most existing systems were designed in the prevailing disease- and payment-focused care paradigm that often loses sight of the goals, needs, and values of patients and clinicians. The goal-directed health care model was proposed more than 20 years ago, but no design principles have been developed for corresponding electronic record systems. Newly designed EHRs are needed to facilitate health care that is anchored by patient life and health goals. We explore the limitations of current EHRs and propose a blueprint for a new EHR design that may facilitate goal-directed health care. To reflect patient goals as a thread through the care continuum, we propose 5 major system functions for goal-directed health records based on the 8 characteristics of primary health care defined by the Institute of Medicine. We also discuss how new EHR functions could support goal-directed health care and how payment and quality measurement systems will need to be transformed. It may be possible for patient life and health goals to drive health care that is reinforced by a corresponding health record design; however, synchronized shifts must occur in the models of providing, documenting, and paying for health care.
      Keywords: Health policy, Coordination / integration of care, Personalized care, Communication / decision making, Health informatics
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2180
      Issue No: Vol. 16, No. 2 (2018)
       
  • A Narrative Approach to Healing Chronic Illness [Reflection]

    • Authors: Egnew T. R.
      Pages: 160 - 165
      Abstract: Many clinicians may feel poorly prepared to manage patient suffering resulting from the travails of chronic illness. This essay explores the thesis that chronically and terminally ill patients can be holistically healed by transcending the suffering occasioned by the degradations of their illnesses. Suffering is conveyed as a story and clinicians can encourage healing by co-constructing patients’ illness stories. By addressing the inevitable existential conflicts uncovered in patients’ narratives and helping them edit their stories to promote acceptance and meaning, suffering can be transcended. This requires that clinicians be skilled in narrative medicine and open to engaging the patient’s existential concerns. By helping patients transcend their suffering, clinicians claim their heritage as healers.
      Keywords: Chronic illness, Professional practice, Communication / decision making, Mindfulness and reflection, Spirituality, Social / cultural context, Patient perspectives
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2182
      Issue No: Vol. 16, No. 2 (2018)
       
  • You Will Have a New Life [Reflection]

    • Authors: Finkelstein A.
      Pages: 166 - 167
      Abstract: This narrative presents my personal reflections as a medical anthropology researcher, and my journey as a chronic patient suffering for 30 years from ulcerative colitis. My surgeon promised me "a new life" after recommending a total colectomy 20 years ago. Indeed, a new life did begin following surgery, but I find I must renegotiate the challenges and rewards of this new life nearly every day.
      Keywords: Chronic illness, Mental health, Mindfulness and reflection, Patient perspectives
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2181
      Issue No: Vol. 16, No. 2 (2018)
       
  • From Transactional Tasks to Personalized Care: A New Vision of Physicians
           Roles [Reflection]

    • Authors: Reuben, D. B; Sinsky, C. A.
      Pages: 168 - 169
      Abstract: Changes in health care delivery have affected the work that physicians are expected to perform and, in turn, their satisfaction. There is a gap between the professional mission—what physicians want to do (eg, caring relationships with patients, using intellectual and technical skills to help people, autonomy in their daily work) and what physicians spend a substantial portion of their time and energy doing (eg, data entry and forced function work). We believe that steps can be taken to align the current and future practice of medicine with the professional mission that motivates physicians and creates satisfaction. These steps focus on shifting physicians’ responsibilities away from transactional tasks and towards personalized aspects of care. By taking steps to close the gap between mission and daily work, physicians will again be able to find joy, purpose, and meaning in their profession and give back what patients and society need from 21st century physicians
      Keywords: Health policy, Health services, Professional practice, Coordination / integration of care, Personalized care, Relationship, Patient-centered medical home
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2203
      Issue No: Vol. 16, No. 2 (2018)
       
  • When Its Time to Retire: Notes From the Afterlife [Reflection]

    • Authors: Loxterkamp D.
      Pages: 171 - 174
      Abstract: At the end of the Second World War, the US birth rate peaked at nearly 27 births per 1,000 population–a rate unparalleled in the previous 3 decades, and one that would not be repeated. That Boomer generation is now retiring. How do those of us caught in the wave feel about stepping back' Who will step in to replace us' And how will we replace the loss of purpose and fulfillment that comes from a career in medicine' A lengthening life expectancy has challenged many of us to consider the "second act" to our adult life. This essay describes the emotional turbulence of ending one career and contemplating the next.
      Keywords: Older adults, Professional practice, Relationship, Mindfulness and reflection, Spirituality, Organizational / practice change, Social / cultural context
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2204
      Issue No: Vol. 16, No. 2 (2018)
       
  • Citizen Engagement in Primary Care [Innovations in Primary Care]

    • Authors: Kiran, T; Davie, S, MacLeod, P.
      Pages: 175 - 175
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2185
      Issue No: Vol. 16, No. 2 (2018)
       
  • Ordering Labs as a Team [Innovations in Primary Care]

    • Authors: Panzer J.
      Pages: 176 - 176
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2207
      Issue No: Vol. 16, No. 2 (2018)
       
  • SOCIAL DETERMINANTS OF HEALTH IN FAMILY MEDICINE RESIDENCY EDUCATION
           [Family Medicine Updates]

    • Authors: Clements D. S.
      Pages: 178 - 178
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2211
      Issue No: Vol. 16, No. 2 (2018)
       
  • IMPLEMENTING PRIMARY HEALTH CARE POLICY UNDER CHANGING GLOBAL POLITICAL
           CONDITIONS: LESSONS LEARNED FROM 4 NATIONAL SETTINGS [Family Medicine
           Updates]

    • Authors: van Weel, C; Turnbull, D, Bazemore, A, Garcia-Pena, C, Roland, M, Glazier, R. H, Phillips, R. L, Goodyear-Smith, F.
      Pages: 179 - 180
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2214
      Issue No: Vol. 16, No. 2 (2018)
       
  • FAMILY PHYSICIANS CONTINUE MOVE TO NEW PAYMENT MODELS, AAFP SURVEY FINDS
           [Family Medicine Updates]

    • Authors: Laff M.
      Pages: 180 - 181
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2215
      Issue No: Vol. 16, No. 2 (2018)
       
  • TAMMY CHANG, MD, MPH, MS SELECTED AS 2017 NAM PUFFER/ABFM FELLOW [Family
           Medicine Updates]

    • Pages: 181 - 181
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2213
      Issue No: Vol. 16, No. 2 (2018)
       
  • STFM ENHANCES ITS LEADING CHANGE OFFERINGS [Family Medicine Updates]

    • Pages: 182 - 182
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2219
      Issue No: Vol. 16, No. 2 (2018)
       
  • ADFM AND FMAHEALTH BOARDS ENGAGEMENT AROUND A PUBLIC MEMBER PILOT STUDY
           [Family Medicine Update]

    • Authors: Grumbach, K; Gilchrist, V, Davis, A, Hobbs, J, Worthington, M, Schneider, F. D, Stream, G, OConnor, M, Campbell, T.
      Pages: 182 - 183
      PubDate: 2018-03-12T14:00:17-07:00
      DOI: 10.1370/afm.2212
      Issue No: Vol. 16, No. 2 (2018)
       
 
 
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