Annals of family medicine
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Annals of family medicine · Jan 2023
Engaging with Brown Buttabean Motivation for Sustained Weight Loss.
Context Brown Buttabean Motivation (BBM) is a grassroot Pacific-led organisation aiming to reduce obesity amongst Pasifika (Pacific people in Aotearoa New Zealand) and Indigenous Maori, helping them choose a healthy and active life-style for themselves, their children and their wider family. BBM offers a holistic approach to weight loss, recognising that mental health, family and cultural factors all play essential and critical roles in nutrition and physical activity patterns. Objective To understand how participants experience and engage with BBM. ⋯ BBM is a community-embedded Maori and Pasifika-led intervention, with no reliance on researchers nor external authorities for its ongoing implementation. It addresses factors impacting participants' lives and social determinants of health, including vaccination drives, food parcels and adapting to the COVID-19 pandemic and lockdowns. Our three-year longitudinal cohort study assessing sustained weight loss is ongoing.
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Annals of family medicine · Jan 2023
Trends in Pediatric Primary Care Visits During the COVID-19 Pandemic.
Context: The COVID-19 pandemic has impacted the volume and nature of pediatric primary care visits nationwide. Objective: This study aimed to identify trends in pediatric visits during COVID-19 at our institution to reveal challenges and opportunities to improve care. Study Design: Retrospective chart review of all pediatric visits from January 1, 2019 through September 30, 2021 using the electronic health record (EHR). ⋯ Video visit volume decreased from 2020-2021 in all age categories except for adolescents aged 12-<18, which remained stable at 43% of all visits. Conclusions: A sharp increase in behavioral health concerns among adolescents stands out as the most notable impact of COVID-19 on pediatric care at our institution. Our findings raise questions about how behavioral health care can be optimized for children and adolescents now and in the post-pandemic era.
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Annals of family medicine · Jan 2023
Randomized Controlled Trial Multicenter StudyInhaled Budesonide for COVID-19 in People at Higher Risk of Complications in the Community: The UK National Community Randomi.
Background The effectiveness of repurposed treatments with supportive evidence for higher risk individuals with COVID-19 in the community is unknown. In the UK PRINCIPLE national platform trial we aimed to determine whether 're-purposed medicines' (hydroxychloroquine, azithromycin, doxycycline, colchicine, inhaled budesonide, and other interventions) reduced time to recovery and COVID-19 related hospitalisations/deaths among people at higher risk of COVID-19 complications in the community. We mainly report the findings for budesonide arm here. ⋯ An estimated 6·8% COVID-19 related hospitalisations/deaths occurred in the budesonide group versus 8·8% in usual care (estimated absolute difference, 2·0% [95% credible interval -0.2% to 4.5%], probability of superiority 0.963). In the main secondary analysis of admissions using only concurrent controls, admissions occurred in 6.6% (3.8 to 10.1%) in the budesonide group versus 8.8% (95% CI 5.2 to 13.1%), with an absolute difference of 2.2% (0.0 to 4.9%) and a hazard ratio of 0.73 (0.53 to 1.00), meeting the pre-specified superiority probability of 0.975. Three serious adverse events occurred in the budesonide group and three in usual care.
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Annals of family medicine · Jan 2023
ReviewReview of Patient Outcomes After Referral to OT Embedded Within a Primary Care Practice.
Context: Interprofessional teams can reduce workload of primary care providers (PCP). Currently, there is no standardization regarding which professionals should be on the team. We completed a 2 year pilot imbedding an occupational therapist (OT) within a family medicine team. ⋯ Learning Objectives: OT imbedded within a primary care team can result in efficient and successful treatment of a wide variety of patient complaints. OT services embedded within a primary care team are reimbursable by Medicare and commercial insurance plans. Research Category: Original research Study Design: Retrospective chart review.
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Annals of family medicine · Jan 2023
Multicenter StudyMachine Learning Prediction of Urine Cultures in Primary Care.
Context: Antibiotics for suspected urinary tract infection (UTI) is appropriate only when an infection is present. Urine culture is definitive but takes >1 day to result. A machine learning urine culture predictor was recently devised for Emergency Department (ED) patients but requires use of urine microscopy ("NeedMicro" predictor), which is not routinely available in primary care (PC). ⋯ Simulation of a hypothetical, retrospective clinical trial suggests the NoMicro model could be used to avoid antibiotic overuse by safely withhold antibiotics in low-risk patients. Conclusions: The hypothesis that the NoMicro predictor generalizes to both PC and ED contexts is supported. Prospective trials to determine the real-world impact of using the NoMicro model to reduce antibiotic overuse are appropriate.