The Journal of family practice
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In overweight and obese patients, exercise interventions using a pedometer increase steps by about a mile per day over the same interventions without access to pedometer information and are associated with a modest 4 mm Hg reduction in systolic blood pressure (BP) over baseline. In overweight patients with diabetes, pedometer use with nutritional counseling is associated with 0.86 kg greater weight loss than nutritional counseling alone.
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This first issue in the Hot Topics in COPD and Asthma Management series (issue 1) with Dr. Brown focuses on unmet needs in COPD symptom assessment and management and discusses practical approaches for addressing these unmet needs.
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Pain management with opioids in primary care is challenging. The objective of this study was to identify the number of opioid-related tasks in our clinics and determine whether opioid-related tasks occur more often in a residency setting. ⋯ Primary care physicians prescribe significant amounts of opioids. Due to the nature of opioid use and abuse, a well-planned protocol customized to the practice or institution is required to streamline this process and decrease the number of unnecessary phone calls and follow-ups. Pain management with opioids in primary care is challenging, and many physicians find it unsatisfying and burdensome. More than 60 million patient visits for chronic pain occur annually in the United States, consuming large amounts of time and resources. Contributing to the challenge is the need to ensure patient safety and satisfaction, as well as staff satisfaction with pain management. Opioid-related death is a major cause of iatrogenic mortality in the United States: From 1999 to 2006, fatal opioid-involved intoxications more than tripled from 4000 to 13,800. At issue for many providers, as well as patients and staff, is dissatisfaction with current systems in place for managing chronic non-cancer pain with opioids. In developing this study, we decided to focus on the systems aspect of care with 2 primary outcome measures in mind. Specifically, we sought to identify the tasks related to managing opioids and other controlled substances in 2 primary care clinics in a university-based family medicine program and to determine what proportion of all routine tasks in these 2 clinics could be attributed to opioid-related issues. With our secondary outcome measures, we sought to compare the number of opioid-related tasks in the residency setting with those in a nonresidency setting, and to identify factors that might be associated with an increase in the number of opioid-related tasks.
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A 49-year-old woman visited our family medicine clinic because she'd had 3 episodes of epistaxis during the previous month. She'd already visited the emergency department, and the doctor there had treated her symptomatically and referred her to our clinic.