J Am Board Fam Med
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Case Reports
Angiotensin-Converting Enzyme (ACE) Inhibitor-Induced Angioedema of the Small Bowel: A Diagnostic Dilemma.
Angioedema of the tongue, oral mucosa, and pharynx is a highly visible and easily diagnoseable side effect of Angiotensin-converting enzyme inhibitors (ACEI). Angioedema of the small bowel is a rarer, and underrecognized, adverse event that may present as a diagnostic challenge due to its nonspecific symptoms and lack of visibility, and because of a general lack of awareness of it among physicians. Failure to consider ACEI-induced angioedema of the small bowel in differential diagnoses may result in unnecessary interventions and delay of treatment. ⋯ In the literature, we found that age, patient demographics, and careful medical reconciliation, paired with diagnostic clues in radiology, can assist in accurate diagnosis. More broadly, family and emergency medicine physicians, surgeons, radiologists, and internists should be aware of this rare side effect caused by this commonly prescribed medication to avert unnecessary medical treatments and procedures.
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Prior research suggests an association between parental experiencing of 1 or more adverse childhood experiences (ACEs) and increased risk for overweight/obesity in children. However, the pathways through which parental experiences of ACEs lead to child weight are unclear. ⋯ Study findings suggest that intervening on parent low mental health may be a key factor in reducing the intergenerational transmission between parental ACEs and child weight.
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Continuity is a core component of primary care and known to differ by patient characteristics. It is unclear how primary care physician payment and organization are associated with continuity. ⋯ Our results suggest that continuity does not differ substantially by physician payment or organizational model among primary care patients who are formally enrolled with a physician in a setting with universal health insurance.
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Medical assistants are core members of the primary care team, but health care organizations struggle to hire and retain them amid the ongoing exodus of health care workers as part of the "Great Resignation." To sustain a stable and engaged workforce of medical assistants, we argue that efforts to hire and retain them should focus on making their work worthwhile. Work that is worthwhile includes adequate pay, benefits, and job security, but additionally enables employees to experience a sense of contribution, growth, social connectedness, and autonomy. ⋯ We also connect these components to the work design literature to show how clinic managers and supervising clinicians can promote worthwhile work through decision-making and organizational climate. Going beyond financial compensation, these components target the latent occupational needs of medical assistants and are likely to forge employee-employer relationships that are mutually valued and sustained over time.
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We examined the impact of various comorbid conditions on diabetes and condition-specific cost-related nonadherence (CRN), and HbA1c in adults with diabetes. ⋯ CRN in patients with diabetes is higher than in other comorbid conditions and is associated with poor diabetes control. These findings may be driven by higher out-of-pocket costs for medications to manage diabetes, lack of symptoms associated with poor diabetes control, or other factors, with implications for both clinicians and health insurance programs.