Postgraduate medicine
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Postgraduate medicine · Sep 2020
Redesigning Primary Care in an Academic Medical Center: Lessons, Challenges, and Opportunities.
To evaluate patient access, provider productivity, and patient satisfaction during a 24-month redesign process of an academic medical center, which requires balance between clinical and educational missions. ⋯ While this project was limited to one site, the inclusion of a set of well-planned metrics, and tracking of processes over time can provide insight for ongoing primary care redesign efforts at similar sites seeking to balance the academic mission with clinical productivity and high patient satisfaction.
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Postgraduate medicine · Sep 2020
The 'attended alone' and 'attended with' signs in the assessment of cognitive impairment: a revalidation.
Objectives: To examine the diagnostic utility of the 'attended alone' (AA) and 'attended with' (AW) signs for the diagnosis of major and minor neurocognitive disorder. Methods: Consecutive unselected new outpatient referrals (N = 1209) to a dedicated cognitive disorders clinic over a 5-year period (2015-2019 inclusive) were observed for the AA and AW signs. Criterion diagnoses were by usual clinic assessment using standard (DSM-5) diagnostic criteria. ⋯ Diagnostic utility of AW and AA was independent of patient gender. Conclusion: AW and AA are easily observed and categorized signs. AW has a high sensitivity for cognitive impairment while AA has a high positive predictive value for its absence.
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Health care has become increasingly fragmented, partly due to advancing medical technology. Patients are often managed by various specialty teams when presenting with symptoms that could be manifestations of different diseases. Approximately one third of them are referred to specialists, at over half for outpatient appointments. ⋯ Communication between doctors could improve continuity. There are many differences and similarities in the pathophysiology, symptomatology, diagnosis, and treatment of fibromyalgia, Sjogren's syndrome, and depression. Understanding the associations between fibromyalgia, Sjogren's syndrome and depression should improve clinical outcome via a common holistic approach.
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Postgraduate medicine · Sep 2020
Assessment of Adequacy of Respiratory Infection Prevention in Hospitals of Inner Mongolia, China: A Cross-sectional Study using Unannounced Standardized Patients.
Recent respiratory infectious disease (RID) outbreaks of influenza and the novel coronavirus have resulted in global pandemics. RIDs can trigger nosocomial infections if not adequately prevented. ⋯ There is a need to improve respiratory infectious disease procedures in our study hospitals, especially in outpatient and emergency departments.
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Objectives: Atopic dermatitis, or eczema, is an inflammatory illness that impacts individuals of all ages. The cost of treating AD and the impact on the quality of life have not been well documented in the state of Nevada. This study seeks to fill this gap by identifying factors that impact the cost of AD in the state utilizing clinical and patient demographics. ⋯ In the outpatient setting, physician type, region, and African American race remained significant (p < 0.05). Conclusions: Data from this study indicate that the AD cost burden is dependent on both demographic and clinical factors in the state of Nevada. These differences suggest that patients with AD may encounter higher costs depending on age, race, and clinical factors.