Journal of general internal medicine
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Review Meta Analysis
A Network Meta-Analysis of Clinical Management Strategies for Treatment-Resistant Hypertension: Making Optimal Use of the Evidence.
With the addition of surgical interventions to current medicinal treatments, it is increasingly challenging for clinicians to rationally choose among the various options for treating patients with apparent treatment-resistant hypertension (ATRHTN). This study aims to establish the comparative effectiveness of mineralocorticoid receptor antagonists (MRA), renal denervation (RDN), darusentan and central arteriovenous anastomosis (CAA) for patients with ATRHTN by performing a network meta-analysis. ⋯ When compared to MRA as anchor, darusentan, CAA and RDN are not more effective in achieving a clinically significant reduction in ambulatory blood pressure in individuals with apparent treatment-resistant hypertension.
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Some healthcare systems are relieving primary care providers (PCPs) of "the burden" of managing chronic pain and opioid prescribing, instead offloading chronic pain management to pain specialists. Last year the Centers for Disease Control and Prevention recommended a biopsychosocial approach to pain management that discourages opioid use and promotes exercise therapy, cognitive behavioral therapy and non-opioid medications as first-line patient-centered, multi-modal treatments best delivered by an interdisciplinary team. In the private sector, interdisciplinary pain management services are challenging to assemble, separate from primary care and not typically reimbursed. ⋯ The IPT clinic has demonstrated significant success in opioid risk reduction. Unfortunately, proposed legislation threatens to dismantle aspects of the VA such that these interdisciplinary services may be eliminated. This Perspective explains why it is critical not only to maintain interdisciplinary pain services in VHA, but also to consider disseminating this model to other health care systems in order to implement patient-centered, guideline-concordant care more broadly.
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Language barriers disrupt communication and impede informed consent for patients with limited English proficiency (LEP) undergoing healthcare procedures. Effective interventions for this disparity remain unclear. ⋯ A bedside interpreter phone system intervention to increase rapid access to professional interpreters was associated with improvements in patient-reported informed consent and should be considered by hospitals seeking to improve care for patients with LEP; however, these improvements did not eliminate the language-based disparity. Additional clinician educational interventions and more language-concordant care may be necessary for informed consent to equal that for English speakers.
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Demand for faculty with teaching expertise is increasing as medical education is becoming well established as a career pathway. Junior faculty may be expected to take on teaching responsibilities with minimal training in teaching skills. ⋯ The TEACH certificate program provides inexperienced faculty teachers an opportunity to develop core skills. Satisfaction is high. Future research should focus on the impact that this and similar programs have on teaching skills.
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Multicenter Study
Interprofessional Education in the Internal Medicine Clerkship Post-LCME Standard Issuance: Results of a National Survey.
Several decades of work have detailed the value and goals of interprofessional education (IPE) within the health professions, defining IPE competencies and best practices. In 2013, the Liaison Committee for Medical Education (LCME) elevated IPE to a U.S. medical school accreditation standard. ⋯ Since LCME standard issuance, only a minority of IM clerkships have included formal IPE activities, with lectures as the predominant method. Opportunities exist for enhancing educational methods as well as IPE faculty development.