Journal of general internal medicine
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The impact of proton pump inhibitors (PPIs) use on worsening renal function is controversial and lacks a solid pathophysiological explanation. ⋯ No clinically relevant differences were observed for worsening kidney function between PPIs and H2-blockers initiators. PPIs users presented a reduced risk of AKI compared to ranitidine initiators.
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Alcohol use disorder (AUD) is common and may complicate type 2 diabetes (T2DM) management. Little research has examined diabetes outcomes for people with T2DM and AUD, including during the window when patients start specialty addiction treatment. ⋯ Patients with co-occurring T2DM and AUD in an integrated health care delivery system are vulnerable to diabetes complications that could be addressed during the early phase of specialty addiction treatment.
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The outpatient continuity clinic experience is a crucial component of internal medicine residency training. While in many contexts the teaching physician must be physically present for key parts of the patient encounter, some outpatient environments qualify for use of the Primary Care Exception Rule (PCER), which allows indirect supervision of residents for low-complexity visits. Despite pervasive use of the PCER in resident continuity clinics, the literature regarding its effects on various stakeholders is limited. ⋯ We also suggest best practices for its use: to wit, we advise against using the PCER when the history and/or physical exam is critical to the diagnosis and/or management of the patient's chief concern, and advocate for competency-based, rather than time-based, benchmarks for resident supervision under it. We make recommendations for PCER reform, most importantly expanding the PCER to moderate-complexity visits once competency-based assessments have been instituted. We conclude with future directions for research to improve application of the PCER.