J Am Board Fam Med
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Change champions are important for moving new innovations through the phases of initiation, development, and implementation. Although research attributes positive health care changes to the help of champions, little work provides details about the champion role. ⋯ Practice transformation requires a sustained improvement effort that is guided by a larger vision and commitment and assures that individual changes fit together into a meaningful whole. Change champions--both project and organizational change champions--are critical players in supporting both innovation-specific and transformative change efforts.
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Early awareness, recognition, and treatment of angina can help prevent or delay an acute myocardial infarction and potentially delay death. A patient's educational level may affect a physician's diagnosis of angina and/or a patient's symptom recognition. The objective of this study was to determine whether low education is a risk factor for undiagnosed angina. ⋯ Low education is associated with undiagnosed angina. These results underscore the need for providers to ask about angina symptoms and confirm patients' understanding of their angina diagnosis among those with low education.
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Randomized Controlled Trial
Azithromycin for bronchial asthma in adults: an effectiveness trial.
Macrolides have antimicrobial and anti-inflammatory properties that may be useful in the treatment of chronic asthma. ⋯ Adults with asthma who were randomized to azithromycin did not show statistically significant improvement in asthma outcomes, although the study was underpowered to detect clinical improvement in 15% (number needed to treat = 7). Adults with severe persistent asthma who elected OL treatment documented clinical improvements in asthma symptoms, AQL, and asthma control that persisted after completion of OL azithromycin (number needed to treat = 2).
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As the largest and most widely distributed of primary care physicians, family physicians have an important role in providing women's health care, especially in rural and underserved areas. The proportion of family physicians who are attending to women is declining. Policy intervention may be needed to help family physicians maintain the comprehensiveness of care necessary to address the wide range of medical problems of women they encounter within their practices.
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Afebrile neutropenia with an absolute neutrophil count (ANC) of zero in a nonimmunocompromised individual is unusual. Outlined is a case of agranulocytosis likely due to levamisole laced cocaine. Given recent publications in the news media and medical journals, this is a pertinent issue for primary care providers. ⋯ Our patient did not fit the clinical picture for malignancy, viral infection, or bone marrow pathology. Given the high rate of levamisole adulterated cocaine and an otherwise negative work-up, this is the most likely explanation for her agranulocytosis.