J Am Board Fam Med
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Case Reports
Cannabinoid hyperemesis and compulsive bathing: a case series and paradoxical pathophysiological explanation.
Cannabinoid hyperemesis is a syndrome characterized by severe nausea and hyperemesis associated with chronic marijuana abuse and marked by compulsive bathing habits, which temporarily alleviate symptoms. We describe the syndrome in 4 adult patients for whom extensive gastrointestinal evaluations failed to identify another clear cause. Cessation of marijuana use resulted in the alleviation of their symptoms. Because recreational and medical use of marijuana is increasing in the United States, this condition should be considered in many patients who present with cyclical vomiting.
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Helping patients navigate the complex and fragmented US health care system and coordinating their care are central to the patient-centered medical home. We evaluated the pilot use of a patient navigator (PN), someone who helps patients use the health care system effectively and efficiently, in primary care practices. ⋯ Patient navigation in community primary care practices is useful for patients who have complex needs. Integrating such services into primary care settings will require new practice and payment models to realize the full potential of integrated patient navigation services in this setting.
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This study describes a large database of closed medical professional liability (MPL) claims involving family physicians in the United States. The purpose of this report is to provide information for practicing family physicians that will be useful in improving the quality of care, thereby reducing the incidence of patient injury and the consequent frequency of MPL claims. ⋯ MPL issues are common and are important to all practicing family physicians. Knowledge of the details of liability claims should assist practicing family physicians in improving quality of care, reducing patient injury, and reducing the incidence of MPL claims.
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In the United States, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as the predominant cause of skin infections. Trimethoprim-sulfamethoxazole (TMP-SMX) and clindamycin are often used as first-line treatment options, but clinical data are lacking. ⋯ Our findings reinforce the belief that incision and drainage and antibiotics are critical for the management of CA-MRSA skin infections. Patients who receive TMP-SMX or clindamycin for their CA-MRSA skin infections experience similar rates of treatment failure.
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Primary care providers' (PCPs') provision of time alone with an adolescent without the parents present (henceforth referred to as "confidential care") has a significant impact on adolescents' disclosure of risk behavior. To inform the development of interventions to improve PCPs' delivery of confidential care, we obtained the perspectives of adolescent males and their mothers about the health care concerns of adolescent males and the provision of confidential care. ⋯ To increase adolescents' perception of the relevance of primary care and to foster disclosure during health encounters, our participants described the critical nature of a strong doctor-patient relationship and positive physician demeanor and personalized messages, especially in the context of a continuity relationship. Regular, routine inclusion of confidential care time starting early in adolescence, as well as discussion of the purpose and limitations of confidentiality with parents and adolescents, could lead to greater parental comfort with confidential care and increased disclosure by the adolescent.