Family practice
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Poor nutrition remains a significant public health concern that is often managed within primary care settings. Meanwhile, to our knowledge, there have been few studies that evaluate the intent of primary care providers to offer nutrition services, nor what type of exchanges they engage in to ensure those programs can be implemented. ⋯ Provider respondents found that implementing nutrition programs in primary care settings is difficult and that effective interventions for nutrition within health settings are limited without community-based partnerships and programming. Additional research is needed to measure existing community ties and how such ties could improve patient nutrition.
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The purpose of this study was to assess the impact of SARS-COV-2 (Severe acute respiratory syndrome coronavirus 2) pandemic on primary care management (frequency of monitoring activities, regular prescriptions, and test results) of older adults with common chronic conditions (diabetes, hypertension, and chronic kidney disease) and to examine whether any changes were associated with age, sex, neighbourhood income, multimorbidity, and frailty. ⋯ In the first 14 months of the pandemic, the frequency of common elements of chronic condition care did not notably change overall or among higher-risk patients.
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Case Reports
Kratom use disorder: case reports on successful treatment with home induction of buprenorphine-naloxone.
Kratom has been used for different reasons such as pain, opioid withdrawal, and relaxation. Kratom can cause dependence and overdose, and it's classified under 'drugs of concern' by the US Drug Enforcement Administration. Despite these concerns, kratom is legal in most of the United States and many countries around the world with easy accessibility. Literature searches reveal recommendations to use buprenorphine (or buprenorphine-naloxone), which are medications to treat opioid use disorder, in order to treat patients with kratom use disorder; however, there are no formal guidelines available. Buprenorphine (or buprenorphine-naloxone) induction is recommended to be conducted under observation (i.e. in the clinic) in the United States, but COVID-19 has resulted in shifts toward telehealth. ⋯ Telehealth followed by unobserved buprenorphine-naloxone induction at home may be an alternative to traditional buprenorphine-naloxone induction where treatment accessibility is limited. In addition to daily doses of kratom use, other factors, such as duration of kratom use and individual psychological factors may determine the most comfortable dose of buprenorphine-naloxone.
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Empathetic listening can be particularly challenging with patients presenting pressured speech, while time pressure and costs limit practitioners' availability. We aimed to explore general practitioners' (GPs') experiences when encountering a patient with pressured speech without pathological syndrome. ⋯ The time and energy required to provide adequate care for patients presenting with pressured speech make it quite challenging, and this builds up pressure in the waiting room. But when medical demands take this form, there is a risk that clinicians will reject the patient or refer early to mental health services, leading to growing feelings of abandonment, the neglect of organic issues, and medical nomadism. Initial and continuing medical training focussing on advanced communication skills and multifocal approaches can foster long-term follow-up.
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Musculoskeletal corticosteroid injection (CSI) is a frequently used treatment, considered safe with a low incidence of minor side effects. ⋯ Musculoskeletal corticosteroid injection appears to substantially increase the risk of acute coronary syndrome.