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181. Structured Clinical Documentation to Improve Quality and Support Practice-Based Research in Headache. (PubMed)

of building a customized structured clinical documentation support toolkit, specific for patients seen in a headache specialty clinic. The content was developed through frequent physician meetings to reach consensus on elements that define clinical Best Practices. Tasks were assigned to the care team and data mapped to the progress note.The toolkit collects hundreds of fields of discrete, standardized data. Auto scored and interpreted score tests include the Generalized Anxiety Disorder 7-item, Center (...) Structured Clinical Documentation to Improve Quality and Support Practice-Based Research in Headache. To use the electronic medical record (EMR) to optimize patient care, facilitate documentation, and support quality improvement and practice-based research, in a headache specialty clinic.Many physicians enter data into the EMR as unstructured free text and not as discrete data. This makes it challenging to use data for quality improvement or research initiatives.We describe the process

2018 Headache

182. The practice of medicine has experienced its own version of climate change

to make the best recommendation for each and every patient under their care. Physicians receive some of the most rigorous education and training of any profession. They spend the better part of a decade preparing to practice in whatever specialty and setting they choose. Physicians are the “perfectionists,” “workaholics,” and the “superheroes” of health care. They strive to do it all, and patients expect them to. Physicians put in the extra hours, take on complex cases, and complete the administrative (...) The practice of medicine has experienced its own version of climate change The practice of medicine has experienced its own version of climate change The practice of medicine has experienced its own version of climate change | | September 29, 2018 4 Shares When you or a loved one is sick or injured, health care decisions are fundamentally a matter of trust. You trust your physician will have the answers you need, because you know that, as a highly-trained medical professional, they’re qualified

2018 KevinMD blog

183. Should your practice hire a physician assistant or nurse practitioner?

practitioners and physician assistants is expected to grow at a much faster rate than the average for all jobs due to a physician shortage in many regions and an aging population that requires more healthcare services. Specialties, authority, and best-fit workplace settings NPs often focus on primary care, as well as women’s health, geriatrics, and pediatrics. They can specialize in other areas, such as psychiatry, orthopedics or urgent care. PAs may specialize as well, with emergency medicine, surgery (...) hired PAs in the past tend to hire PAs in the future, and the same holds true for providers that have hired NPs. It is wise to consider multiple factors, including state laws and the level of autonomy you expect. It may be wise to interview both physician assistants and nurse practitioners, because sometimes the “best fit” person may not be the one you expect. Nurse practitioners and physician assistants are not interchangeable, but both play an increasingly important role in medical practices

2018 KevinMD blog

184. Fight burnout: Practice medicine with purpose

Fight burnout: Practice medicine with purpose Fight burnout: Practice medicine with purpose Fight burnout: Practice medicine with purpose | | September 7, 2018 274 Shares I remember climbing into my mother’s office chair and pretending to be the doctor. I was six years old then, wearing her oversized white coat with its sleeves hanging over my small hands. She was a practicing physician in a time period that no longer exists — communist Armenia. This was a time when physicians made about (...) , and love for her patients and colleagues. Her stores were what inspired me years later, to pursue medicine myself. Fast forward to 2018, when I am practicing medicine here in the United States, in the most affluent country there ever was in the world. Yet, there is not a week that goes by when I don’t hear stories of lament about cut wages and reimbursements, challenging patients and toxic work environments. Yes, physicians today do not make nearly as much as we did 30 or 50 years ago. However, I often

2018 KevinMD blog

185. Recontacting or not recontacting? A survey of current practices in clinical genetics centres in Europe. (PubMed)

Recontacting or not recontacting? A survey of current practices in clinical genetics centres in Europe. Advances in genomic medicine are improving diagnosis and treatment of some health conditions, and the question of whether former patients should be recontacted is therefore timely. The issue of recontacting is becoming more important with increased integration of genomics in 'mainstream' medicine. Empirical evidence is needed to advance the discussion over whether and how recontacting should (...) be implemented. We administered a web-based survey to genetic services in European countries to collect information about existing infrastructures and practices relevant to recontacting patients. The majority of the centres stated they had recontacted patients to update them about new significant information; however, there were no standardised practices or systems in place. There was also a multiplicity of understandings of the term 'recontacting', which respondents conflated with routine follow-up

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2018 European Journal of Human Genetics

186. KevinMD’s 2018 top posts: Highlighting the voices of practicing clinicians

KevinMD’s 2018 top posts: Highlighting the voices of practicing clinicians KevinMD's 2018 top posts: Highlighting the voices of practicing clinicians KevinMD’s 2018 top posts: Highlighting the voices of practicing clinicians | | December 27, 2018 118 Shares With over 22 million page views for the year, thank you for making 2018 such a success. KevinMD continues to be the web’s leading platform that highlights the voice of the many who intersect with our health care system, but are rarely heard (...) elsewhere: physicians, advanced practitioners, nurses, medical students, and patients who can share their insight and tell their stories. This year, I’m proud of launching , my boutique physician speakers bureau, and , a dedicated career center ready to support your career at every stage. During these uncertain health care times, it’s more important than ever to highlight the voices of practicing clinicians that are often ignored on traditional outlets. Going into my 15th year, I’m just getting started

2018 KevinMD blog

187. Canadian clinical practice guidelines for acute and chronic rhinosinusitis

Canadian clinical practice guidelines for acute and chronic rhinosinusitis Canadian clinical practice guidelines for acute and chronic rhinosinusitis | Allergy, Asthma & Clinical Immunology | Full Text Advertisement Menu Search Search all BMC articles Search Menu We'd love your feedback. Please complete this 3 question Table of Contents , Gerald A Evans , Paul K Keith , Erin D Wright , Alan Kaplan , Jacques Bouchard , Anthony Ciavarella , Patrick W Doyle , Amin R Javer , Eric S Leith , Atreyi (...) provides healthcare practitioners with a brief, easy-to-read review of information regarding the management of ARS and CRS. These guidelines are meant to have a practical focus, directed at first-line practitioners with an emphasis on patient-centric issues. The readership is considered to be family physicians, emergency physicians, or other point-of-care providers, as well as specialists in otolaryngology-head and neck surgery, allergy and immunology, or infectious disease who dispense first-line care

2011 CPG Infobase

188. Code of practice and performance standards for forensic pathologists in England, Wales and Northern Ireland (produced with the Home Office, Forensic Science Regulator and Department of Justice)

and police. The use of practice meetings to review complex cases is a worthwhile approach. The value of review by peers cannot be overstressed and will be referred to throughout this document. The pathologist must not work in isolation from colleagues, either within the discipline of forensic pathology or from other clinical disciplines. Assistance from other specialists Practitioners must have in place adequate arrangements whereby they can consult with experts in other medical specialties who may (...) to the examination of the scene and body and PUB 250918 10 V2 Final e) the best location for the autopsy and, if possible, an approximate time of arrival at that location. The pathologist must make a detailed, dated and timed record of the briefing. 4.2 Code of practice The pathologist must ensure that he obtains such details of the circumstances of the death as are available. He should be briefed by either the SIO or another officer delegated for this task by the SIO. This briefing should be carried out

2012 Royal College of Pathologists

189. Delivering PACT-Principled Care: Are Specialty Care Patients Being Left Behind? (PubMed)

) clinics as a model to test the extent to which such patients receive PCMH-principled care.To examine the extent to which HIV specialty care in VA conforms to PCMH principles.Qualitative study.Forty-one HIV providers from seven HIV clinics and 20 patients from four of these clinics.We conducted semi-structured interviews with HIV clinic providers and patients about care practices and adherence to PCMH principles. Using an iterative approach, data was analyzed using both a content analysis (...) coordination. Patients from the less PCMH-principled clinics reported less satisfaction with their care.Even in a large, integrated healthcare system, there is wide variation in patients' receipt of PCMH-principled care in specialty care settings. In order to meet the goal of having all patients receiving PCMH-principled care, there needs to be careful consideration of where primary and specialty care services are delivered and coordinated. The best mechanisms for ensuring that patients with complex

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2014 Journal of General Internal Medicine

190. Consent and confidentiality in genetic practice: Guidance on genetic testing and sharing genetic information

scenario 8 13 Clinical scenario 9 14 © Royal College of Physicians and Royal College of Pathologists 2011 iii Under Revision Please use alongside background document published June 20174.2 Adults lacking capacity 14 4.2.1 What are ‘best interests’? 14 Clinical scenario 10 14 Clinical scenario 11 15 5 The use of familial information in clinical genetic practice 16 5.1 The family history as an aid to genetic diagnosis 16 Clinical scenario 12 16 Clinical scenario 13 16 5.2 Use of medical records (...) Montgomery Professor in Health Care Law, University of Southampton vi © Royal College of Physicians and Royal College of Pathologists 2011 Under Revision Please use alongside background document published June 2017Introduction to the revised version This report aims to provide up-to-date guidance on issues of consent and confidentiality arising in clinical genetic* practice. The first version of this guidance was aimed specifically at professionals within the specialty of clinical genetics and was partly

2011 Royal College of Pathologists

191. Panel report: best practices for the surgical treatment of obesity. (PubMed)

Panel report: best practices for the surgical treatment of obesity. Bariatric surgery is a rapidly growing field. Advances in surgical technologies and techniques have raised concerns about patient safety. Bariatric surgeons and programs are under increased scrutiny from regulatory agencies, insurers, and public health officials to provide high quality and safe care for bariatric patients at all phases of care.During the 2009 annual meeting of the Society of American Gastrointestinal (...) and Endoscopic Surgeons (SAGES), a panel of experts convened to provide updated information on patient safety and best practices in bariatric surgery. The following article is a summary of this panel presentation.Weight loss surgery is a field that is evolving and adapting to multiple external pressures. Safety concerns along with increasing public scrutiny have led to a systematic approach to defining best practices, creating standards of care, and identifying mechanisms to ensure that patients consistently

2011 Surgical endoscopy

192. Family Practice Notebook Updates 2018

Family Practice Notebook Updates 2018 Family Practice Notebook Updates 2018 Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Family (...) Practice Notebook Updates 2018 Family Practice Notebook Updates 2018 Aka: Family Practice Notebook Updates 2018 , FPN Updates 2018 II. Updates: December 2018 (er, cv, bleed) Primary priority is the identification of as shock cause, localizing site, and rapidly stopping further bleeding Avoid overly aggressive crystaloid infusion, and aside from , allow permissive with SBP 80-100 mmHg Rapidly transfer to and operating room for definitive management for persistent compartment Consider TXA ( ) within

2019 FP Notebook

193. Compare your own practice patterns to the national average. Here’s how.

in this dataset. Even within an individual specialty, there may be different practice patterns that limit direct comparison between individual physicians. One example would by emergency physicians who work primarily in non-hospital owned free-standing emergency centers, which do not accept Medicare insurance by regulation. Therefore, a direct comparison between a hospital-based emergency physician and a non-hospital owned free-standing facility emergency physician would be inappropriate. Another limitation (...) costs of running a practice. Therefore, the Medicare payment dataset does not distinguish between high-overhead and low-overhead procedures or specialties. Specialists who perform a lot of high-overhead procedures, such as ophthalmologists or radiation oncologists, will have higher Medicare reimbursements than physicians who mostly bill for office visits. In medicine and in business, revenue does not equal profit, so comparing physicians in other specialties, or even within the same specialty, would

2017 KevinMD blog

194. Diagnosis of complicated parapneumonic effusion by pleural pH measurement is jeopardized by inadequate physician knowledge and guideline-discordant laboratory practice. (PubMed)

Diagnosis of complicated parapneumonic effusion by pleural pH measurement is jeopardized by inadequate physician knowledge and guideline-discordant laboratory practice. Pleural fluid pH is a crucial determinant of complicated parapneumonic effusion diagnosis and the need for drainage. It is best measured by blood gas analyzer. We examined whether physicians were aware of this, and whether their laboratories measured pleural pH according to their expectations. Only 53% of physicians understood (...) the need for blood gas analyzer measurements, only 50% of laboratories used blood gas analyzers, and only 35% of physicians correctly identified the method performed in their laboratory. Diagnosis of complicated parapneumonic effusion is jeopardized by inadequate physician knowledge and guideline-discordant laboratory practice. We recommend cooperation between thoracic and biochemistry specialty societies to rectify this issue.Copyright © 2016 Elsevier Ltd. All rights reserved.

2017 Respiratory medicine

195. Can independent practices stay viable using price transparency?

deductibles would cover. Posting basic outpatient visit and simple procedure prices could benefit our independent practices in the same way. The only thing worse than not having health insurance, is having coverage be so expensive you cannot afford to utilize it when necessary. It is like sleeping next to a chocolate cake every night while on a diet. Mexico lags behind most Organization for Economic Co-operation and Development (OECD) countries in health status; however, they are the best in one (...) , the more a consumer reaps the benefits of your expertise, and the busier the practice becomes. Private specialty care could be provided in this straightforward, streamlined way as well. Patients are clearly willing to travel outside the country for good quality medical care at a pre-defined cost, so why not walk across the street from the large hospital waiting room to an independent physicians’ office? Free-market medical care encourages healthy competition; which is bad for the “administrators

2017 KevinMD blog

196. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Colon Cancer. (PubMed)

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Colon Cancer. The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines Committee is composed of society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal (...) surgery. This committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than to dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care

2017 Diseases of the Colon & Rectum

197. Access to Ophthalmologists in States Where Optometrists Have Expanded Scope of Practice. (PubMed)

Access to Ophthalmologists in States Where Optometrists Have Expanded Scope of Practice. As the United States considers how to best structure its health care services, specialty care availability is receiving increased focus. This study assesses whether patients lack reasonable access to ophthalmologists in states where optometrists have been granted expanded scope of practice.To determine the estimated travel time (ETT) to the nearest ophthalmologist office for persons residing in states (...) that have expanded scope of practice for optometrists, and to quantify ETT to the nearest ophthalmologist for Medicare beneficiaries who received surgical care from optometrists in those states between 2008 and 2014.This study used data from the 2010 US census, a 2016 American Academy of Ophthalmology member database, and a data set of claims data for a random sample of 20% of beneficiaries enrolled in Medicare nationwide from 2008 to 2014 (n=14 063 725). Combining these sources with geographic

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2017 JAMA ophthalmology

198. Why do doctors who hate being doctors still practice?

Why do doctors who hate being doctors still practice? Why do doctors who hate being doctors still practice? Why do doctors who hate being doctors still practice? | | November 20, 2017 492 Shares How important is it for a doctor to want to be a doctor? At first glance, that question is ludicrous. The path to becoming a practicing physician is so long and tortuous that no one would do it if they didn’t want to. Right? First, there’s the four years of undergraduate education, then four years (...) . They volunteer at a hospital to get their hours in so their application to medical school will be strong; they end up mostly escorting patients, and they like the chit-chat. They shadow a specialist who’s a friend of a parent. It isn’t the most interesting work they’ve ever seen, but then, that specialty isn’t really what they had in mind — it’s just a way to get the hours in so they can apply to medical school. They apply. In their interview, they’re poised, confident without being arrogant and have well

2017 KevinMD blog

199. Clinical medical education in rural and underserved areas and eventual practice outcomes: A systematic review and meta-analysis. (PubMed)

Clinical medical education in rural and underserved areas and eventual practice outcomes: A systematic review and meta-analysis. Undergraduate medical students are enrolled in clinical education programs in rural and underserved urban areas to increase the likelihood that they will eventually practice in those areas and train in a primary care specialty to best serve those patient populations.MEDLINE and Cochrane Library online databases were searched to identify articles that provide (...) criteria. Of those, ten articles were identified for qualitative analysis and five articles included control groups and thus were included in the quantitative analysis. Results indicated that medical students with clinical training in underserved areas are almost three times as likely to practice in underserved areas than students who do not train in those areas (relative risk [RR] = 2.94; 95% confidence interval [CI]: 2.17, 4.00). Furthermore, medical students training in underserved areas are about

2017 Education for health (Abingdon, England)

200. Take back our practices with physician cooperatives

of the norm rather than the exception. As I learn more, I am sure that all of the pros and cons of this model will become evident, but I believe that physician cooperatives could be a game changing model for physicians that creates the best of both worlds: access for patients, and the opportunity for physicians to once again truly practice medicine on their terms. Maiysha Clairborne is an integrative medicine physician and can be reached at . She is the author of . Image credit: … … 53 Shares Tagged (...) Take back our practices with physician cooperatives Take back our practices with physician cooperatives Take back our practices with physician cooperatives | | September 14, 2017 53 Shares One of the biggest points of contention in the ongoing discussion of burnout is that the system of health care is flawed. The endless bureaucracy, decreasing physician pay, and increasing meaningful use requirements that spawn endless clicking on an already inefficient electronic medical record platform have

2017 KevinMD blog

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