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Spartanburg, United States

Menzies R.D.,John Peter Smith Hospital | Young R.A.,Family Medicine Residency Program
British Journal of Sports Medicine | Year: 2011

Objective To describe the impact of an expanded primary care-based sports medicine clinic on referrals to an orthopaedics clinic and to describe the patients seen and procedures performed. Design Retrospective cohort study. Setting Primary care-based sports medicine clinic and orthopaedics clinic at a tax-supported American safety net healthcare system. Participants All patients referred to the sports medicine clinic by other primary care physicians over a 1-year time period of July 2006-June 2007. Main outcome measures The referral rate from sports medicine clinic to orthopaedics clinic, the percentage of referred patients who were recommended surgery by the orthopaedists, the change in average waiting time to be seen in orthopaedics clinic and the most common conditions and procedures. Results 4925 patients were seen by the sports medicine department; 118 (2.4%) of those patients were referred to the orthopaedic department. Of the referred patients, surgery was offered by orthopaedists to 80 (68%) patients. The average wait for initial consultation by the orthopaedic spine clinic decreased from 199 to 70 days; the wait for general orthopaedic clinic decreased from 97 to 19 days. No single patient complaint or musculoskeletal pathology predominated: knee degenerative joint disease (25.3%), mechanical low back pain (21.6%) and lumbar disc disease (19.9%). Knee injections and epidural steroid injections were the most common procedures performed. Conclusions Very few patients with musculoskeletal pathology were referred by a primary care-based sports medicine clinic to an orthopaedics clinic. Of the referred patients, sports medicine physicians and orthopaedists frequently agreed on the need for surgery. Expansion of a primary care-based sports medicine service could help relieve overburdened orthopaedics departments of patients with conditions not requiring surgery. Source

Myerholtz L.,University of North Carolina at Chapel Hill | Carling M.A.,Family Medicine Residency Program
International Journal of Psychiatry in Medicine | Year: 2015

Beginning behavioral science faculty, who are critical residency program contributors, face significant immediate challenges that often diminish their effectiveness and increase the time it takes to translate and reformat their expertise into relevant and meaningful educational presentations. Residency program culture and competency- based learning are quite different from the educational objectives and teaching environments found in most behavioral health training programs. The goal of this article is to provide beginning behavior science faculty, who are typically on their own and learning on the job, with a guide to the core educational perspectives and skills required as well as key resources that are available to them. Since a significant portion of behavioral science faculty's teaching time revolves around small and large group presentations, our guide focuses on how to incorporate key strategies and resources into relevant, evidenced-based and, most importantly, effective behavioral health presentations for the program's resident physicians. Specifically, our recommendations include selection of content, methods of content organization, techniques for actively engaging resident physicians in discussing the significance of the topics, and descriptions of numerous Internet resources for the primary mental health topics that concern family medicine trainees. Finally, it is emphasized that the relevant and effective use of these recommendations is dependent upon the behavioral science faculty educator's first understanding and appreciating how physicians' think, speak, and prioritize information while caring for their patients. © The Author(s) 2015. Source

Haque R.,Michigan State University | Watkins D.,Family Medicine Residency Program
Annals of Long-Term Care | Year: 2014

Oral health is often neglected in older adults, particularly those in long-term care facilities. To help address this issue, physicians and other healthcare professionals should routinely perform oral health assessments, including for patients wearing dentures. These assessments could be integrated into routine physical examinations or when an oral health problem is identified. In this article, the authors report the case of a patient who developed mastication-associated rhinorrhea after many years of using a dental device. Upon the patient noting this troubling symptom, the authors performed a thorough oral examination, which enabled them to identify the etiology and recommend an intervention that would have been successful had the patient followed through. Source

Skolnik N.S.,Family Medicine Residency Program | Skolnik N.S.,Temple University | Ryan D.H.,Pennington Biomedical Research Center
Journal of Family Practice | Year: 2014

Obesity is a multifactorial disease that results from a combination of both physiological, genetic, and environmental inputs. Obesity is associated with adverse health consequences, including T2DM, cardiovascular disease, musculo-skeletal disorders, obstructive sleep apnea, and many types of cancer. The probability of developing adverse health outcomes can be decreased with maintained weight loss of 5% to 10% of current body weight. Body mass index and waist circumference are 2 key measures of body fat. A wide variety of tools are available to assess obesity-related risk factors and guide management. Source

Horst M.A.,Lancaster General Research Institute | Coco A.S.,Family Medicine Residency Program
Journal of the American Board of Family Medicine | Year: 2010

Background: The recent implementation of electronic medical record systems allows for the development of systems to track common illness across a defined community. With the threats of bioterrorism and pandemic illness, syndromic surveillance methodologies have become an important area of study. There has been limited study of the application of syndromic surveillance techniques to communities for tracking common illnesses to improve health system resource allocation and inform communities. Methods: We analyzed visits from 26 primary care sites and one emergency department in a health system during a 13-month period in 2007 to 2008. Visits were coded for common respiratory and gastrointestinal illnesses. Using geographic information systems techniques, we plotted home addresses and developed criteria for census tract inclusion. The spatial distribution of the illnesses patterns was analyzed using Bayesian smoothing, Kriging and SaTScan (SaTScan, Boston, MA) statistical methods. Results: The study included 857,555 visits, 107,286 of which were in the emergency department and 750,269 in the primary care sites. Patient visits were plotted and then aggregated to census tracts. We determined that at least a median of 10 visits per week was required to provide sufficient volume in defining census tracts included in the study (109 census tracts). Weekly visit rates by census tract were plotted using nearest neighbor empirical Bayesian smoothing and Kriging to produce a continuous surface. To detect statistical clustering of weekly visit rates, we used SaTScan and identified 7 weeks with statistically significant clusters for respiratory illnesses and 8 weeks with statistically significant clusters for gastrointestinal illnesses (out of 56 weeks included in the study). After adjusting for population density, the visit rate remained consistent for respiratory illnesses (analysis of variance P = .937), but the visit rate for gastrointestinal illnesses increased in the fourth population density quartile (statistically different from quartiles 1, 2 and 3; analysis of variance P < .001 with Tukey multiple comparisons test), which included the highest population density areas in the study. Conclusions: We were able to use geographic information systems to assess visit rates for common illnesses in a defined community and identified spatial variability over time. Additional research is needed to help define parameters for implementation, but we believe this can have benefit for allocation of health resources and communicating with the community. Source

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