The Mount Sinai journal of medicine, New York
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Patients with serious illnesses are living longer and with greater disabilities. Palliative-care interventions have been shown to increase quality of life, lower costs, and improve survival. ⋯ By working together, many more patients and families will receive the comprehensive, individualized, coordinated care and support that both primary care and palliative care offers to patients. This article will review literature illustrating the benefits of palliative care; discuss why primary-care clinicians are ideally suited to incorporate palliative care into their practice; and provide guidance to primary-care clinicians regarding how and when to access palliative-care specialist services, how to gain more training in palliative care, and how to be reimbursed for palliative-care visits.
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The Meyerhoff Scholars Program at the University of Maryland, Baltimore County is widely viewed as a national model of a program that enhances the number of underrepresented minority students who pursue science, technology, engineering, and mathematics PhDs. The current article provides an overview of the program and the institution-wide change process that led to its development, as well as a summary of key outcome and process evaluation research findings. African American Meyerhoff students are 5× more likely than comparison students to pursue a science, technology, engineering, and mathematics PhD. ⋯ Qualitative findings from interviews and focus groups demonstrate the importance of the Meyerhoff Program in creating a sense of belonging and a shared identity, encouraging professional development, and emphasizing the importance of academic skills. Among Meyerhoff students, several precollege and college factors have emerged as predictors of successful entrance into a PhD program in the science, technology, engineering, and mathematics fields, including precollege research excitement, precollege intrinsic math/science motivation, number of summer research experiences during college, and college grade point average. Limitations of the research to date are noted, and directions for future research are proposed.
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Providers and hospitals have received more than $5 billion from the federal government for meaningfully using electronic health records as of April 2012. Meaningful Use stage 1 makes adoption of the personal health record optional. The proposed Meaningful Use stage 2 regulations make personal health record use mandatory. ⋯ The literature also supports the use of secure messaging required in stage 2. However, there is little evidence to support other stage 2 personal health record requirements and dependencies. Further study is urgently needed to ensure that Meaningful Use stage 2 is meaningful for both patients and providers.
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The causes of homelessness are complex and multifactorial and the solutions equally complex. Though homelessness is not a disease process, it is directly linked to poor health outcomes. ⋯ These factors needed to be accounted for when designing treatment plans in a way that will increase access to care and promote adherence. Increasing compliance and addressing barriers to care will improve outcomes and may reduce overall health expenditures.
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With growing numbers of patient-centered medical homes and accountable care organizations, and the potential implementation of the Patient Protection and Affordable Care Act, the provision of primary care in the United States is expanding and changing. Therefore, there is an urgent need to create more primary-care physicians and to train physicians to practice in this environment. In this article, we review the impact that the changing US healthcare system has on trainees, strategies to recruit and retain medical students and residents into primary-care internal medicine, and the preparation of trainees to work in the changing healthcare system. ⋯ Retaining residents in primary-care careers may be encouraged via focused postgraduate fellowships or continuing medical education to prepare primary-care physicians as both teachers and practitioners in the changing environment. Finally, to prepare primary-care trainees to effectively and efficiently practice within the changing system, educators should consider shifting ambulatory training to community-based practices, encouraging resident participation in team-based care, providing interprofessional educational experiences, and involving trainees in quality-improvement initiatives. Medical educators in primary care must think innovatively and collaboratively to effectively recruit and train the future generation of primary-care physicians.