Journal of general internal medicine
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Randomized Controlled Trial
Lifestyle Habits Associated with Weight Regain After Intentional Loss in Primary Care Patients Participating in a Randomized Trial.
Though long-term weight loss maintenance is the treatment goal for obesity, weight regain is typical and few studies have evaluated lifestyle habits associated with weight regain. ⋯ Consuming less fish, fewer steps per day, and more frequent restaurant eating were most consistently associated with weight regain in primary care patients. Primary care providers may consider addressing specific lifestyle behaviors when counseling patients after successful weight loss.
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Randomized Controlled Trial
Impact of Clinical Decision Support on Antibiotic Prescribing for Acute Respiratory Infections: a Cluster Randomized Implementation Trial.
Clinical decision support (CDS) is a promising tool for reducing antibiotic prescribing for acute respiratory infections (ARIs). ⋯ The iCPR tool was not effective in reducing antibiotic prescription rates for upper respiratory infections in diverse primary care settings. This has implications for the generalizability of CDS tools as they are adapted to heterogeneous clinical contexts.
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Few assessments capture the diagnostic impressions medical students form immediately following patient encounters. However, notes written for objective structured clinical examinations (OSCEs) allow learners to document their clinical reasoning in real time. The University of Illinois at Chicago College of Medicine (UIC-COM) has developed a rubric for scoring patient notes (PNs) in their OSCE for senior students. ⋯ We showed an association between PN scores and clinical rotation performance. Since clinical rotation grades incorporate multiple types of assessments of students' clinical reasoning skills, we believe that this correlation lends validity evidence to using the note-writing task as a measure of clinical reasoning. Future directions include expanding the task to different stages of learners, to real life patient encounters, and to formative rather than summative assessments of note-writing skills.
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Little is known about the level of burnout among program administrators (PAs) in medical education and its impact on the trainee environment. ⋯ PA burnout levels fluctuate over the academic year and are shown to increase as feelings of isolation grow.
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Collaborative models for depression have not been widely adopted throughout the USA, possibly because there are no successful roadmaps for implementing these types of models. ⋯ Collaborative care for depression can be institutionalized in large healthcare systems and be sustained with a specific, detailed roadmap that includes workflows, training, treatment guidelines, and clear documentation standards that are linked to performance metrics. Extensive stakeholder engagement at every level is also critical for success.