The latest medical research on MedicalDirector software
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about medicaldirector software gathered by our medical AI research bot.
The selection below is filtered by medical specialty. Registered users get access to the Plexa Intelligent Filtering System that personalises your dashboard to display only content that is relevant to you.
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Request AccessBuilding physician wellness into the culture: evaluating a family physician well-being programme using the physician wellness inventory.
Family PracticeFamily physicians have a higher incidence of burnout, dissatisfaction, and disengagement compared to other medical specialties. Addressing burnout on the individual and systemic level is important to promoting wellness and preventing deleterious effects on physicians and patients. We used the Physician Wellness Inventory (PWI) to assess the effects of a wellness programme designed to equip family physicians with skills to address burnout.
The PWI is a fourteen-item 5-point Likert scale broken down into 3 scores; (i) career purpose, (ii) cognitive flexibility, and (iii) distress. The PWI was distributed to a cohort of n = 111 family physician scholars at 3 time points: January 2021, May-June 2021, and October 2021. The response rate was 96.4% at baseline, and 72.1% overall. Demographic information was collected to assess differences. The survey was distributed online through Qualtrics (Provo, UT).
Cognitive Flexibility scores at the endpoint were higher for POC scholars than white scholars (P = 0.024). Distress scores for all groups decreased over time. Female scholars were more nervous, and anxious at the start than male scholars (P = 0.012), which decreased over time (P = 0.022). New career scholars were more likely than later career scholars to be distressed (P = 0.007), but both groups' distress decreased over time (P = 0.003). Later career scholars' feelings of being bothered by little interest or pleasure in doing things decreased more than new career scholars (endpoint: P = 0.022; overall: P = 0.023).
The wellness programme shows improvement in PWI scores, indicating the programme content should be evaluated further for system level improvements.
Comparison of skin cancer risk between renal transplant recipients and patients with glomerular diseases in rural Queensland.
Aust J RuralThere is increased risk of skin cancer in patients with gloermular disease or those with renal transplant.
To compare the risk of skin cancer between kidney recipients (KTRs) and patients with glomerular disease (GD).
The cohort comprised patients with KTRs (n = 61) and GD (n = 51) in Central and Central West Queensland, Australia. A quantitative cohort study was undertaken to study the risk of skin cancer in rural communities between two subgroups of patients with kidney diseases in relationship to immunosuppression. Statistical analyses of the differences in incidence of skin cancers between the two groups were done by chi-square test, Fisher's exact test, independent t-test and McNemar's test.
KTRs with non-melanoma skin carcinoma (NMSC) increased significantly after treatment with immunosuppressants (pre-transplantation, n = 11 [18.0%], post-transplantation, n = 28 [45.9%]; p < 0.001). There were no differences in number of patients with NMSC observed in the GD group (pre-diagnosis, n = 6 [11.8%], post-diagnosis, n = 7 [13.7%]; p = 1.000). Compared to the risks at 1 year post-immunosuppressants, the incidence of NMSC of KTRs increased significantly at 3 years (20.3% vs. 35.4%, p < 0.001) and 5 years (20.3% vs. 62.2%, p < 0.001) post-immunosuppressants, whereas the increased incidence of NMSC was observed only at 5 years (2.1% vs. 11.8%, p = 0.012) in the GD cohort. The mean cumulative number of NMSC in KTRs increased significantly at 3 years (p = 0.011), and 5 years (p = 0.001) post-immunosuppressants, compared to the risks at 1 year post-immunosuppressants, however, no differences were noted in the GD cohort.
In patients with a high risk of NMSC, reducing skin cancer risk should be considered in conjunction with the optimisation of treatment.
The true complexities of "standard" family practice visits unmasked: an observational cross-sectional study in Regina.
Family PracticeMany patients present to their family medicine clinic with more than one health concern, placing an increased demand on family physicians. Research into the average number of concerns per regular family medicine visit is limited. Recognition of the frequency that family physicians address more than one concern per visit and adapting practices accordingly is important for improving patient care.
To examine whether family physicians routinely address multiple different patient concerns during a single visit and if this is influenced by patient demographics.
This study was conducted at a multi-physician family medicine clinic in Regina, Saskatchewan, Canada. Five physicians contributed their 500 most recent charts, extending retrospectively from 1 June 2023, from in-person visits by patients over 18 years of age and billed as regular appointments without billed procedures. Each chart was reviewed for the number of concerns addressed in the visit.
Fifty percent of visits addressed more than 1 concern (range = 1-8). A generalized linear mixed model using Poisson distribution showed certain physicians (incident rate ratio [IRR]: 1.192, 95% CI: 1.087-1.307, P < 0.001) and adults older than 65 years compared to adults less than 40 years (IRR 1.151, 95% CI: 1.069-1.239, P < 0.001) were more likely to present with multiple concerns, but patient sex was not a significant predictor.
Family physicians routinely address more than one concern per visit. Standard visit length and billing practices should be adapted to reflect this complexity.
Outcomes of different perioperative management strategies of patients on chronic anticoagulation in elective total hip and knee arthroplasty: a systematic review.
Family PracticeThere are currently different management guidelines for patients undergoing elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) that are on long-term anticoagulation. The timing of discontinuation and restarting the anticoagulation is challenging during the postoperative care, which often involves general practitioners and physiotherapists.
Systematic Review of Level III studies.
Six retrospective studies involving 727 patients with therapeutic anticoagulation (1,540 controls) for elective THA, TKA and revision arthroplasty have been included. The follow-up ranged from 30 days to 1 year postoperatively. All studies evaluated outcomes of warfarin therapeutic anticoagulation versus prophylactic dosages of one or more of the following: warfarin, aspirin, low-molecular-weight heparin (LMWH) and unfractionated low-dose heparin (UFH). One study did not discontinue therapeutic anticoagulation. Two studies reported no significant differences in complications between groups, whilst 3 studies had significantly higher rates of superficial wound infections, revision surgeries, postoperative haematomas, and prosthetic joint infections (PJI).
Different anticoagulation-related perioperative management strategies achieve different outcomes following elective arthroplasty in patients with therapeutic chronic anticoagulation. There is contradictory evidence regarding the need for the discontinuation of therapeutic warfarin. Retrospective data showed that individual risk stratification with multi-modal prophylaxis resulted in minimal complications.
Supporting rehabilitation practice for COVID-19 recovery: a descriptive qualitative analysis of allied health perspectives.
Aust Health RevObjectiveThe study aimed to explore the perspective of healthcare workers on the resources they need to provide quality rehabilitation for people r...
The creation of Grampians Health - a case study focusing on lessons learned from a health service merger.
Aust Health RevThis case study of the merger of four hospitals in western Victoria reports on the views of participants affected by the merger - as staff or from ...
Factors that influence scope-of-practice decisions of early-career family physicians: Focus group study in Canada.
Can Fam PhysicianTo explore perceptions of early-career family physicians on the personal, educational, organizational, community, and system factors that had influenced their scope-of-practice decisions and to compare the similarities and differences among these factors across all 13 Canadian jurisdictions.
Data were collected using focus groups and were analyzed using deductive and inductive analysis techniques to identify patterns in the data within and across jurisdictions.
Participants across all jurisdictions highlighted that personal factors (ie, interest, work-life balance and family life, financial considerations, and self-perceived competence and confidence) were most influential on scope-of-practice decisions. Educational (ie, exposure during training, mentorship), organizational (ie, collegial support), community (ie, needs), and system (ie, payment models, funding for team-based care, governance) factors also influenced decisions about scope of practice. Experiences were similar across all jurisdictions for personal factors. Differences in experiences were reported across jurisdictions for educational, organizational, community, and system factors.
Decisions about scope of practice by early-career family physicians are highly influenced by personal factors followed by organizational, educational, community, and system factors. These findings suggest numerous strategies are needed to increase individuals' interest in providing comprehensive care in Canada. Educators should cultivate interest in comprehensive care among learners, strategically recruit trainees, provide targeted exposure and experiences, ensure competence and confidence are evaluated throughout and at the end of training, and introduce formal mentorship programs. Policy-makers should invest in the spread of effective team models and alternative payment models. Together, these strategies could broaden the scopes of practice of family physicians and their capacity to deliver accessible and comprehensive care to Canadians.
Barriers and facilitators for family physicians prescribing opioid agonist therapy in Saskatchewan.
Can Fam PhysicianTo explore barriers and facilitators for family physicians in Saskatchewan prescribing opioid agonist therapy (OAT).
Descriptive and inferential statistics of physicians' self-reported barriers to and facilitators of prescribing OAT for opioid use disorder (OUD).
Most respondents (84.8%) had some comfort with diagnosing OUD. However, more than half (58.3%) did not feel confident or knowledgeable about prescribing OAT. Barriers to OAT prescribing included lack of time, incomplete training requirements, lack of interest, insufficient funding or support, feeling overwhelmed, and perceiving that OAT does not work and thus is not necessary. Physicians working in core neighbourhoods and those receiving fee-for-service compensation reported the least available time to prescribe OAT. Conversely, physicians working in interdisciplinary team settings had increased time for OAT prescribing compared with physicians in other settings. Having a close personal relationship with someone with OUD was correlated with increased comfort in diagnosing OUD as well as with knowledge about and confidence in prescribing OAT. Themes identified as facilitators to increasing OAT prescribing included the addition of resources and supports, increased training, more awareness about OUD and OAT, enhanced compensation, and altered prescribing regulations.
Despite the presence of several real and perceived barriers limiting OAT prescribing by Saskatchewan family physicians, there are family physicians interested in providing this therapy. Increased clinical resources and support, including increased interdisciplinary practice, are actionable steps that should be considered by policy decision makers to address this issue. Additionally, increased OUD and OAT education, which includes the perspectives of those with lived experience of OUD, would help address physician confidence, knowledge, and awareness in this area.
Top studies of 2023 relevant to primary care: From the PEER team.
Can Fam PhysicianTo provide a summary of the noteworthy medical articles published in 2023 that are relevant to family physicians.
Articles were chosen and ranked by the PEER (Patients, Experience, Evidence, Research) team, a group of primary care health professionals focused on evidence-based medicine. The selection process involved routine surveillance of tables of contents in high-impact medical journals and continuous monitoring of EvidenceAlerts. Articles were prioritized based on their direct applicability to and potential to influence primary care practice.
Selected articles addressed various clinical areas of primary care. The topics included a comparison of a treat-to-target approach versus a high-intensity statins prescription for lipid management; semaglutide and its impact on cardiovascular outcomes; respiratory syncytial virus vaccine for older adults; chlorthalidone versus hydrochlorothiazide in preventing cardiovascular events; amitriptyline for irritable bowel syndrome; the role of opioids in acute back pain; safety of oral penicillin challenges in patients allergic to penicillin; spironolactone for facial acne; strategies to reverse frailty in older adults; and identifying the provider of chronic disease management. Two "up and coming" medications are also mentioned: retatrutide for weight loss and fezolinetant for vasomotor symptoms of menopause.
Research published in 2023 yielded several high-quality articles with topics relevant to primary care, including cardiovascular care, irritable bowel syndrome, care of the elderly, and acne management.
Weight Management with Orlistat in Type 2 Diabetes - An Electronic Healthcare Records Study.
Br J GenOrlistat is recommended as an adjunct to diet and exercise for weight loss in type 2 diabetes mellitus (T2DM). The aims were to explore (i) associations between patient characteristics and orlistat prescribing and to determine (ii) associations of orlistat with weight loss in T2DM/prediabetes.
This cohort study used anonymised records of T2DM/prediabetes (2016-2017) patients ≥18 years, from the UK Clinical Practice Research Datalink (CPRD) database. Multivariable logistic regression models determined associations with starting orlistat and stopping it early (<12 weeks of prescriptions) and orlistat's associations with weight loss in those not prescribed 2nd line anti-diabetic medications.
Out of 100,552 patients with incident T2DM/prediabetes, 655 (0.8%) T2DM and 128 (0.7%) prediabetes patients were prescribed orlistat. Younger people, females, those in more deprived regions, current smokers, co-prescribed metformin and recorded with hypertension were significantly more likely to be prescribed orlistat while higher baseline HbA1c levels were associated with early stopping. Those who continued orlistat for >12 weeks were more likely to lose ≥5% weight (adjusted OR: 1.69; 95% CI: 1.07, 2.67) than those not on orlistat, but those who stopped orlistat early were less likely (adjusted OR: 0.56; 95% CI: 0.29, 1.09).
Orlistat was significantly associated with weight loss in T2DM/prediabetes when taken for at least 12 weeks. However, orlistat is infrequently prescribed and often taken for <12 weeks. Orlistat may be a useful adjunct to lifestyle modifications in T2DM/prediabetes however barriers to continuing orlistat means it may not be effective for everyone in managing weight loss.
Continuity and breaches in GP care and their associations with mortality for patients with chronic disease: an observational study using Norwegian registry data.
Br J GenDespite many benefits of continuity of care with a named regular GP (RGP), continuity is deteriorating in many countries.
To investigate the association between RGP continuity and mortality, in a personal list system, in addition to examining how breaches in continuity affect this association for patients with chronic diseases.
The Usual Provider of Care (UPC, value 0-1) Index was used to measure both disease-related (UPCdisease) and overall (UPCall) continuity with the RGP at the time of consultation. In most analyses, patients who changed RGP during the study period were excluded. In the combined group of all four chronic conditions, the proportion of consultations with other GPs and out-of-hours services was calculated. Cox regression models calculated the associations between continuity during 2013-2016 and mortality in 2017-2018.
Patients with COPD with UPCdisease <0.25 had 47% increased risk of dying within 2 years (hazard ratio 1.47, 95% confidence interval = 1.22 to 1.64) compared with those with UPCdisease ≥0.75. Mortality also increased with decreasing UPCdisease for patients with heart failure and decreasing UPCall for those with diabetes. In the combined group of chronic conditions, mortality increased with decreasing UPCall. This latter association was also found for patients who had changed RGP.
Higher disease-related and overall RGP UPC are both associated with lower mortality. However, changing RGP did not significantly affect mortality, indicating a compensatory benefit of informational and management continuity in a patient list system.
Support for primary care prescribing for adult ADHD in England: national survey.
Br J GenAttention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with effective pharmacological treatments that improve symptoms and reduce complications. NICE guidelines recommend primary care practitioners prescribe medication for adult ADHD under shared care agreements with adult mental health services (AMHS). However, provision remains uneven, with some practitioners reporting a lack of support.
This study aimed to describe supportive elements (prescribing, shared care, AMHS availability) of primary care prescribing for adult ADHD medication in England, to inform service improvement and improve access for this underserved population.
Descriptive analyses used percentages and confidence intervals to summarise responses by stakeholder group. Variations in reported provision and practice were explored and displayed visually using mapping software.
Data from 782 respondents (42 Commissioners; 331 HP; 409 LE) revealed differences in reported provision by stakeholder group, including for prescribing (94.6% of HP vs 62.6% of LE). Over 40% of respondents reported extended AMHS waiting times of two years or more. There was some variability by NHS region, for example London had highest rates of HP reported prescribing (100%), and lowest reported extended waiting times (25.0%).
Elements supporting appropriate shared care prescribing of ADHD medication via primary care are not universally available in England. Co-ordinated approaches are needed to address these gaps.
