J Am Board Fam Med
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Randomized Controlled Trial
BREATHE OUT: a randomized controlled trial of a structured intervention to improve clinician satisfaction with "difficult" visits.
Difficult patients comprise at least 15% of ambulatory visits and are associated with clinician burnout. No structured procedure has been reported to assist health care practitioners with these challenging relationships. This randomized trial evaluated whether a pre- and postvisit patient-centered and clinician-reflective technique called BREATHE OUT improved clinician satisfaction during visits with patients perceived by the clinician as difficult. ⋯ Application of the BREATHE OUT questionnaire before and after visits improved clinician satisfaction with difficult patient encounters.
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Case Reports
Staphylococcus epidermidis in urine is not always benign: a case report of pyelonephritis in a child.
Staphylococcus epidermidis in urine cultures from previously healthy children is usually considered to be a contaminant. The goal of this study was to identify cases in which S. epidermidis was an infectious cause of urinary tract infection (UTI) in children. ⋯ UTIs caused by S. epidermidis in a previously healthy child should not be disregarded as a contaminant and further workup for urinary tract abnormality is indicated.
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Patients at risk for suicide often come into contact with primary care providers, many of whom use electronic health records (EHRs) for charting. It is not known, however, how often suicide ideation or attempts are documented in EHRs. ⋯ Few cases of suicidal ideation and attempt were documented in patients' EHRs using diagnostic codes. Increased documentation of suicidal ideation and behaviors in patients' EHRs may improve their monitoring in the health care system.
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The rapidly growing number of adult survivors of preterm birth has necessitated and made possible for the first time large-scale investigations of long-term outcomes of preterm birth. Large epidemiologic studies have shown that the long-term sequelae are wide-ranging, including metabolic disorders, cardiovascular and respiratory disease, psychiatric disorders, and increased mortality risk. ⋯ Family medicine is an ideally conceived discipline for this paradigm because of its unique role in caring for patients across the entire life span. As our understanding of early life influences on long-term health continues to advance, family physicians are ideally positioned to incorporate this knowledge into clinical practice.
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Little is known about patient factors associated with the provision of hypertension care as recommended by JNC 7. ⋯ Hypertension care in 2013 at an academic family medicine center was, for the most part, in agreement with guidelines; however, provision of some items varied based on sex, marital status, and insurance. Awareness of these predictors may help improve the implementation of guidelines, particularly relevant given the recent release of JNC 8.