The Medical clinics of North America
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Med. Clin. North Am. · Jul 2018
ReviewInpatient Addiction Consult Service: Expertise for Hospitalized Patients with Complex Addiction Problems.
Substance use disorders are highly prevalent and are a large driver of costly inpatient medical care; however, historically the substance use disorder has gone unaddressed during an inpatient stay. Inpatient addiction consult services are an important intervention to use the reachable moment of hospitalization to engage patients and initiate addiction treatment. Addiction consultation involves taking an addiction-specific history, motivational interviewing, withdrawal symptom management, and initiation of long-term pharmacotherapy. Addiction consult services have the potential to decrease readmissions and utilization costs for medical systems and improve substance-related outcomes for patients.
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Med. Clin. North Am. · May 2018
ReviewPatient-Centered Bedside Rounds and the Clinical Examination.
Bedside hospital rounds promote patient-centered care in teaching and nonteaching settings. Patients and families prefer bedside rounds and provider acceptance is increasing. Efficient bedside rounds with an interprofessional team or with learners requires preparation of the patient and the rounding team. ⋯ By using relationship-centered communication, rounds can be both patient proximate and patient centered. The clinical examination can be integrated into the flow of the presentation and case discussion. Patient and provider experience can be enhanced through investing time at the bedside.
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The physical examination remains a vital part of the clinical encounter. However, physical examination skills have declined in recent years, in part because of decreased time at the bedside. ⋯ Likelihood ratios are diagnostic weights that allow clinicians to estimate the post-probability of disease. This hypothesis-driven approach to the physical examination increases its value and efficiency, while preserving its cultural role in the patient-physician relationship.
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This article focuses exclusively on physical examination (PE) in the context of clinical medicine, that is, the interaction between a health care provider and patient. In essence, there is not only benefit (value) to PE but also that it will last (endure) for some time. Both "enduring" and "value" are explored in more depth with respect to the future integration of PE into the clinical assessment of a patient and how its value extends well beyond current diagnostic/cost-based metrics.
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Med. Clin. North Am. · May 2018
ReviewClinical Examination Component of Telemedicine, Telehealth, mHealth, and Connected Health Medical Practices.
Telemedicine and telehealth are the practices of medicine at a distance. Performing the equivalent of a complete clinical examination by telemedicine would be unusual. ⋯ Telemedicine clinical examinations are facilitated, and enhanced, through the integration of a class of medical devices referred to as telemedicine peripherals (eg, electronic stethoscopes, tele-ophthalmoscopes, video-otoscopes, and so forth). Direct-to-consumer telehealth is a rapidly expanding segment of the health care service industry.