Journal of investigative medicine : the official publication of the American Federation for Clinical Research
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Review Meta Analysis
Harms of third- and fourth-generation combined oral contraceptives in premenopausal women: A systematic review and meta-analysis.
We assessed the available evidence regarding adverse effects on surrogate and patient-important health outcomes of third- and fourth-generation combined oral contraceptives among premenopausal women. We performed a systematic review and meta-analysis including randomized controlled trials and observational studies comparing third- and fourth-generation combined oral contraceptives with other generation contraceptives or placebo. Studies that enrolled women aged 15 to 50 years, with at least three cycles of intervention and 6 months of follow-up were included. ⋯ In premenopausal women, the use of third- and fourth-generation oral contraceptives is associated with an improved lipid profile and lower risk of arterial thrombosis. Data were inconclusive regarding the rest of outcomes assessed. This review was registered in PROSPERO with CRD42020211133.
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Data on colonoscopy's diagnostic yield in young adults with lower gastrointestinal symptoms are scarce. We evaluated this yield in young patients by performing an indication-based analysis of outcomes. ⋯ We outlined the expected diagnostic yields of colonoscopy performed in young patients for multiple indications, showing that rectal bleeding was consistently associated with CRC and polyp detection.
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American Academy of Pediatrics approves pacifier use for soothing and calming; it recommends delaying its use until breastfeeding is well established. Though pacifiers have protective effects against sudden infant death syndrome, prolonged use of a pacifier can lead to complications. American Academy of Family Physicians discourages the use by 6 months to 1 year of age. ⋯ Eleven (8.3%) caregivers reported that information about pacifiers was provided by medical and day-care providers. Pacifier use was not significantly related to the feeding method during the first 2 months of life. This study identifies impressions and common misconceptions of pacifier use which may assist in the development of comprehensive guidelines.
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Innovations to enhance residency training in interpersonal and communication skills are needed and a resident-led strategy has not been well-described. In this study, we explored a resident-led comprehensive communication skills curriculum for internal medicine residents. Residents and faculty prepared the curriculum as part of an Accreditation Council for Graduate Medical Education (ACGME) Back to Bedside Project and with "The language of caring guide for physicians." Employing active learning techniques, three residents led 43 internal medicine residents in seven 1 h sessions from 2019 to 2020. ⋯ Using a five-point Likert scale, 100% of participants agreed the program improved their communication skills and improved confidence in bedside patient-centered communications. A resident-led comprehensive communication skills curriculum for internal medicine residents was implemented showing improvement in skills over the course of the curriculum. The curriculum was well-accepted by post-survey evaluation and was feasible with motivated resident-leaders, use of an existing guide to communication, and reserved didactic time to implement the program.
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Evidence-based medicine (EBM) is the practice of applying scientific evidence to clinical decision-making, with a focus on addressing the individualized needs and values of patients. It requires not only a solid foundation of medical knowledge and the ability to gather a thorough patient history but also the skills to locate, interpret, and apply relevant principles from the medical literature. ⋯ It is particularly crucial for reducing medical waste, adhering to guidelines, and decreasing morbidity and mortality rates. This paper aims to underscore the significance of increasing residents' exposure to evidence-based approaches in clinical decision-making, propose time-efficient and effective methods to enhance their understanding of EBM, and promote the implementation of evidence-based practices within the inpatient setting.