Texas medicine
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Measuring treatments used by 202 patients with chronic low back pain in the PRECISION Pain Research Registry, this study determined the associations of opioid and nonsteroidal anti-inflammatory drug (NSAID) therapy with clinical status. More than one-fourth of patients did not use nonpharmacologic treatments for low back pain. Patients age 50-59 and 60-79 years old were more likely to use opioids than younger patients. ⋯ No significant associations between pharmacologic therapy and clinical status remained after controlling for potential confounders. Neither opioids nor opioids combined with NSAIDs were more effective than just NSAIDs. Greater use of nonpharmacologic therapies and better second-line, nonopioid pharmacologic therapies appear necessary for more effective treatment of chronic low back pain.
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Since the 1980s, concerns about resident fatigue have caused lawmakers and medical policymakers to pull back on resident duty hours. In 2003 and again in 2011, the Accreditation Council for Graduate Medical Education (ACGME) shortened resident hours. In March, ACGME modified those hours again. The latest rule change has reignited a long-running debate among physicians.
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The purpose of this study was to define the demographics of pediatric traumatic injuries and to understand the predictive value of injury type, prehospital, and emergency department (ED) data regarding the mortality of pediatric trauma patients (<14 years of age) in South Central Texas. We report a retrospective review of pediatric trauma patients presenting to Trauma Service Area P in South Central Texas during 2004-2013. The primary outcome was mortality; secondary outcomes were ventilator days, hospital days, and intensive care unit stay. ⋯ Most injuries overall were caused by motor vehicle collisions; however, burns and falls were most common in infants. The most lethal injuries were caused by firearms (mostly seen in preteens) and assaults (mostly seen in infants). This analysis of injured children in Southwest Texas offers insight into areas of needed quality improvement in the trauma system and potential areas to focus prevention efforts.
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Concierge medicine, a practice model in which the patient pays an annual membership fee or retainer for services that won't be covered by insurance, is garnering more attention from physicians.