Journal of primary care & community health
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J Prim Care Community Health · Jan 2020
Review Case ReportsManagement of Restless Legs Syndrome in Pregnancy and Lactation.
Restless legs syndrome (RLS) affects about 20% of all pregnant women. RLS symptoms are usually moderate to severe in intensity during pregnancy and can result in insomnia, depression, and other adverse outcomes. Although iron deficiency has been implicated as a potential etiological factor, other mechanisms can also play a role. ⋯ We review the literature on the prevalence, diagnosis, course, possible underlying pathophysiologic mechanisms and complications of RLS in pregnancy. We describe current best evidence on the efficacy, and safety of nonpharmacologic therapies, oral and intravenous iron supplementation, as well as other medication treatments for RLS in pregnancy and lactation. We highlight gaps in the literature and provide a practical guide for the clinical management of RLS in pregnancy and during breastfeeding.
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J Prim Care Community Health · Jan 2020
The Role of North Carolina Medical Schools in Producing Primary Care Physicians for the State.
Introduction: Primary care physicians serve on the front lines of care and provide comprehensive care to patients who may have difficulty accessing subspecialists. However, not enough students are entering residency in primary care fields to meet the primary care physician shortage. The authors sought to compare primary care match rates among graduates of medical schools in the state of North Carolina from 2014 to 2018. ⋯ ECU had the highest proportion of its graduates match in a primary care specialty (53%, compared with 34% to 45% at other schools; P < .001), and was particularly distinguished by having the highest proportions of graduates match to residencies in family medicine (18%) and pediatrics (16%). Conclusion: During the study period of 2014-2018, the ECU Brody School of Medicine matched more medical students into primary care specialties than the other medical schools in the state. This school's community-driven mission and rural location, among other characteristics facilitating sustained student commitment to primary care careers, can inform the development of new medical schools in the United States to overcome the primary care physician shortage.
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J Prim Care Community Health · Jan 2020
Comparative StudyChanges in Primary Care Visits in the 24 Weeks After COVID-19 Stay-at-Home Orders Relative to the Comparable Time Period in 2019 in Metropolitan Chicago and Northern Illinois.
In this brief report, we characterize pediatric primary care service utilization in metropolitan Chicago over the first 24 weeks of the COVID-19 pandemic response in relation to the comparable time period in 2019. ⋯ Recovery of well child and immunization visits suggests that practice-level efforts and policy change can ensure children receive recommended care as the pandemic evolves.
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J Prim Care Community Health · Jan 2020
Observational StudyWhom Should We Test for COVID-19? Performance of a Symptom and Risk Factor Questionnaire on COVID-19 Test Results and Patient Outcomes in an Immediate Care Setting.
The CDC and Illinois Department of Public Health disseminated risk factor criteria for COVID-19 testing early in the pandemic. The objective of this study is to assess the effectiveness of risk stratifying patients for COVID-19 testing and to identify which risk factors and which other clinical variables were associated with SARS-CoV-2 PCR test positivity. ⋯ The risk assessment questionnaire was not effective at stratifying patients for testing. Although individual risk factors were associated with SARS-CoV-2 test positivity, the low-risk group had similar positivity rates to the high-risk group. Our observations underscore the need for clinicians to develop clinical experience and share best practices and for systems and payors to support policies, funding, and resources to test all symptomatic patients.
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J Prim Care Community Health · Jan 2020
A Case-Control Study: The Impact of Unintentional Discrepancies and Pharmacist Discharge Prescription Review on 30-Day Hospital Readmission.
Introduction: Medication discrepancies on hospital discharge are common and occur despite the use of technology to generate electronically created discharge (e-discharge) prescriptions, justifying pharmacist involvement. No published studies have focused on medication discrepancies as a risk factor for readmission. The aim was to explore the relationship between medication discrepancies on discharge and readmission rates, and how both are affected by pharmacist intervention. ⋯ Conclusions: Pharmacist review of the e-discharge prescription did not affect the readmission rate. A LACE score of 12 or greater was associated with a higher risk of readmission. Future studies are needed to identify patient groups at high risk of readmission and to determine pharmacist interventions that could reduce readmission rates.