Journal of general internal medicine
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Meta Analysis
Efficacy of Brief Intervention for Unhealthy Drug Use in Outpatient Medical Care: a Systematic Review and Meta-analysis.
The efficacy of brief intervention (BI) for unhealthy drug use in outpatient medical care has not been sufficiently substantiated through meta-analysis despite its ongoing global delivery. This study aims to determine the efficacy of BI for unhealthy drug use and the expected length of effects, and describe subgroup analyses by outpatient setting. ⋯ PROSPERO (CRD42020157733).
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Engaging primary care providers (PCPs) in BRCA1/2 testing and results disclosure would increase testing access. The BRCA Founder OutReach (BFOR) study is a prospective study of BRCA1/2 founder mutation screening among individuals of Ashkenazi Jewish descent that sought to involve participants' PCPs in results disclosure. We used quantitative and qualitative methods to evaluate PCPs' perspectives, knowledge, and experience disclosing results in BFOR. ⋯ Barriers exist to incorporating BRCA1/2 testing into primary care. Most PCPs declined to disclose their patients' BFOR results, although survey respondents were motivated and had positive disclosure experiences. PCP training and integrated decision support could be beneficial.
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Randomized Controlled Trial
An Intensive Intervention to Reduce Readmissions for Frequently Hospitalized Patients: the CHAMP Randomized Controlled Trial.
A small number of patients are disproportionally readmitted to hospitals. The Complex High Admission Management Program (CHAMP) was established as a multidisciplinary program to improve continuity of care and reduce readmissions for frequently hospitalized patients. ⋯ Frequently hospitalized patients experienced reductions in utilization over time. Though most outcomes showed no difference, CHAMP was associated with higher readmissions compared to a control group, possibly due to consolidation of care at a single hospital. Future research should seek to identify subsets of patients with persistently high utilization for whom tailored interventions may be beneficial.
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Editorial Review
What Educators Can Learn from the Biopsychosocial-Spiritual Model of Patient Care: Time for Holistic Medical Education.
Medical students and residents experience burnout at a high rate and encounter threats to their well-being throughout training. It may be helpful to consider a holistic model of education to create educational environments in which trainees flourish. ⋯ The current state of trainee well-being in each of these areas is reviewed. We discuss potential interventions and opportunities for further research to help clinician educators develop a contextualized, holistic approach to the formation of their trainees.
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New bone-directed therapies, including denosumab, abaloparatide, and romosozumab, emerged during the past decade, and recent trends in use of these therapies are unknown. ⋯ Rates of denosumab use outpaced growth of all other bone-directed therapies over the past decade. Treatment rates after osteoporotic fractures were low and declined over time, highlighting major failings in osteoporosis treatment in the US.