Bibliografie tematiche / Family medicine

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Letteratura scientifica selezionata sul tema "Family medicine"

Autore: Grafiati
Pubblicato: 4 giugno 2021
Ultima modifica: 9 giugno 2025

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Articoli di riviste sul tema "Family medicine"

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Akyurek, Cagdas Erkan, Esin Mutluer, and Deniz Tugay Arslan. "A policy analysis study: Family medicine." New Trends and Issues Proceedings on Humanities and Social Sciences 2, no. 2 (January 12, 2016): 76–83. http://dx.doi.org/10.18844/gjhss.v2i2.418.

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Gupta, Archna, Carolyn Steele Gray, Megan Landes, Sanjeev Sridharan, and Onil Bhattacharyya. "Family medicine." Canadian Family Physician 67, no. 9 (September 2021): 647–51. http://dx.doi.org/10.46747/cfp.6709647.

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Bowman, Marjorie A. "Family Medicine." JAMA: The Journal of the American Medical Association 270, no. 2 (July 14, 1993): 205. http://dx.doi.org/10.1001/jama.1993.03510020073021.

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Bowman, M. A. "Family medicine." JAMA: The Journal of the American Medical Association 273, no. 21 (June 7, 1995): 1676–77. http://dx.doi.org/10.1001/jama.273.21.1676.

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Bowman, M. A. "Family medicine." JAMA: The Journal of the American Medical Association 275, no. 23 (June 19, 1996): 1809–10. http://dx.doi.org/10.1001/jama.275.23.1809.

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Bowman, Marjorie A. "Family Medicine." JAMA: The Journal of the American Medical Association 275, no. 23 (June 19, 1996): 1809. http://dx.doi.org/10.1001/jama.1996.03530470037022.

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Schwenk, Thomas L. "Family Medicine." JAMA: The Journal of the American Medical Association 268, no. 3 (July 15, 1992): 356. http://dx.doi.org/10.1001/jama.1992.03490030068031.

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McClintic, William R. "Family Medicine." JAMA: The Journal of the American Medical Association 262, no. 10 (September 8, 1989): 1381. http://dx.doi.org/10.1001/jama.1989.03430100115043.

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Bowman, Marjorie A. "Family Medicine." JAMA: The Journal of the American Medical Association 271, no. 21 (June 1, 1994): 1670. http://dx.doi.org/10.1001/jama.1994.03510450042023.

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Bowman, Marjorie A. "Family Medicine." JAMA: The Journal of the American Medical Association 273, no. 21 (June 7, 1995): 1676. http://dx.doi.org/10.1001/jama.1995.03520450046023.

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Tesi sul tema "Family medicine"

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Eubanks, Jaimie. "Family Medicine." FIU Digital Commons, 2017. https://digitalcommons.fiu.edu/etd/3551.

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The novel FAMILY MEDICINE follows three married women as they struggle to define themselves in Foley, South Dakota, a small town where privacy is nearly impossible. Marcy Morrow, a queen bee, in a vulnerable moment reveals misgivings about her second pregnancy to Bridget Cunningham, the wife of Dr. Herb Cunningham and his office manager at the town’s only medical practice. Bridget's offer of off-the-books help begins a chain of secrecy into which Dr. Maka Smith, the practice’s other physician, is reluctantly pulled. Meanwhile Marcy and Bridget’s husbands run for mayor, forcing the women to reexamine their lives, ambitions, and the nature of friendship. The use of multiple perspectives, as in Anne Tyler’s Dinner at the Homesick Restaurant, helps reveal motives while heightening tension. FAMILY MEDICINE’s focus on a small community, like that Jane Austen’s Emma, uncovers the rivalries, alliances, and power of gossip in a circumscribed world.
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Verdieck-Devlaeminck, Alex, Jim Holt, and Richard Usatine. "Dermoscopy in Family Medicine." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6451.

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Seminar objectives: – Introduce dermoscopy as a method for dermatologic diagnosis – Teach methods to identify melanoma using dermoscopy – Introduce other methods to identify additional skin conditions – Provide resources for learning dermoscopy
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Blackwelder, Reid B. "Alternative Medicine Family Practice." Digital Commons @ East Tennessee State University, 2002. https://dc.etsu.edu/etsu-works/6997.

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Blackwelder, Reid B. "Integrative Medicine." Digital Commons @ East Tennessee State University, 1999. https://dc.etsu.edu/etsu-works/7008.

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Blackwelder, Reid B. "Allopathic Medicine." Digital Commons @ East Tennessee State University, 2002. https://www.amzn.com/1560534400.

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Book Summary: This new reference ― part of The Secrets Series® provides balanced coverage of all current complementary and alternative therapies by leading experts in the field. Discusses each CAM modality and the disorders for which it has been proven beneficial; what to look for in a practitioner of each field; whether there is a "best" CAM approach; supporting evidence; and the effectiveness of CAM compated to allopathic approaches. Includes chapters on the various alternative therapies as well as chapters on medical disorders and the CAM treatments for those diseases Focuses on the evidence for the effectiveness of CAM therapies Kohatsu one of the leaders in the field (member of first group of fellows of Andrew Weil at University fo Arizona Department of Integrative Medicine Book uses an "integrative" approach---not just CAM therapies, but therapies used in conjunction with total program for treating patient's condition (including standard medical therapies, nutrition, etc). Concise answers that include the author's pearls, tips, memory aids, and "secrets".
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Blackwelder, Reid B. "Cardiovascular Medicine." Digital Commons @ East Tennessee State University, 2000. https://dc.etsu.edu/etsu-works/6922.

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Blackwelder, Reid B. "Alternative Medicine." Digital Commons @ East Tennessee State University, 2001. https://dc.etsu.edu/etsu-works/6998.

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Blackwelder, Reid B. "Alternative Medicine." Digital Commons @ East Tennessee State University, 2000. https://dc.etsu.edu/etsu-works/7003.

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Sawa, Russell J. "Family therapy and family medicine, an interdisciplinary epistemology." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0003/NQ34699.pdf.

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Tähepõld, Heli. "Patient consultation in family medicine /." Online version, 2006. http://dspace.utlib.ee/dspace/bitstream/10062/712/5/tahepold.pdf.

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Libri sul tema "Family medicine"

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Taylor, Robert B., Alan K. David, Thomas A. Johnson, D. Melessa Phillips, and Joseph E. Scherger, eds. Family Medicine. New York, NY: Springer New York, 1998. http://dx.doi.org/10.1007/978-1-4757-2947-4.

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Taylor, Robert B., ed. Family Medicine. New York, NY: Springer New York, 1988. http://dx.doi.org/10.1007/978-1-4757-1998-7.

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Taylor, Robert B., Alan K. David, Scott A. Fields, D. Melessa Phillips, and Joseph E. Scherger, eds. Family Medicine. New York, NY: Springer New York, 2003. http://dx.doi.org/10.1007/978-0-387-21744-4.

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Hirsch, Jeffrey G. Family Medicine. New York, NY: Springer US, 1994. http://dx.doi.org/10.1007/978-1-4684-0476-0.

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Taylor, Robert B., ed. Family Medicine. New York, NY: Springer New York, 1994. http://dx.doi.org/10.1007/978-1-4757-4005-9.

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Hirsch, Jeffrey G. Family Medicine. New York, NY: Springer New York, 1996. http://dx.doi.org/10.1007/978-1-4612-4010-5.

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Paulman, Paul, Robert B. Taylor, Audrey A. Paulman, and Laeth S. Nasir, eds. Family Medicine. New York, NY: Springer New York, 2020. http://dx.doi.org/10.1007/978-1-4939-0779-3.

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Knutson, Doug. Family Medicine. New York: McGraw-Hill, 2008.

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Perez, Mayra. Family Medicine. New York: McGraw-Hill, 2008.

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Hirsch, Jeffrey G. Family medicine. 2nd ed. New York: Springer, 1996.

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Capitoli di libri sul tema "Family medicine"

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Geigges, Werner, Kurt Fritzsche, Susan H. McDaniel, Xudong Zhao, Catherine Abbo, Gertrud Frahm, and Sonia Diaz Monsalve. "Family Medicine." In Psychosomatic Medicine, 51–64. New York, NY: Springer New York, 2014. http://dx.doi.org/10.1007/978-1-4614-1022-5_7.

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Clemson, Lindy, J. Rick Turner, J. Rick Turner, Farrah Jacquez, Whitney Raglin, Gabriela Reed, Gabriela Reed, et al. "Family Medicine." In Encyclopedia of Behavioral Medicine, 764. New York, NY: Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4419-1005-9_100626.

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Willems, Dick. "Family Medicine." In Encyclopedia of Global Bioethics, 1–10. Cham: Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-05544-2_189-1.

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Miller, Vivian J. "Family Medicine." In Encyclopedia of Gerontology and Population Aging, 1–7. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-319-69892-2_1095-1.

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Miller, Vivian J. "Family Medicine." In Encyclopedia of Gerontology and Population Aging, 1802–8. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-22009-9_1095.

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Willems, Dick. "Family Medicine." In Encyclopedia of Global Bioethics, 1239–48. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-09483-0_189.

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ten Have, Henk, and Maria do Céu Patrão Neves. "Family Medicine." In Dictionary of Global Bioethics, 509. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-54161-3_250.

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Puffer, James C. "Sports Medicine." In Family Medicine, 703–20. New York, NY: Springer New York, 1988. http://dx.doi.org/10.1007/978-1-4757-1998-7_40.

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Devine, Mathew, and Meg Hayes. "Complementary and Alternative Medicine." In Family Medicine, 1771–84. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-04414-9_47.

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Pohl, Susan, and Katherine Hastings. "Evidence-Based Family Medicine." In Family Medicine, 49–58. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-04414-9_5.

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Atti di convegni sul tema "Family medicine"

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Husain, Fadly, Arif Purnomo, Heri Tjahjono, Puji Lestari, and Eka Yuniati. "The Utilization of Plants as Medicine in Family Medicine: Potential for Conservation of Traditional Knowledge and Nature." In The International Conference on Humanities Education, Law, and Social Science, 147–57. SCITEPRESS - Science and Technology Publications, 2024. https://doi.org/10.5220/0013407000004654.

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Sundberg, Glenda, Jessica Kram, and Sarah Bowlby. "The humans of family medicine." In NAPCRG 49th Annual Meeting — Abstracts of Completed Research 2021. American Academy of Family Physicians, 2022. http://dx.doi.org/10.1370/afm.20.s1.2585.

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Klemenc-Ketiš, Zalika, and Rok Ravnikar. "Burnout in Slovenian Family Medicine Physicians." In »Health Professionals - Stress, Burnout and Prevention«. University of Maribor Press, 2017. http://dx.doi.org/10.18690/978-961-286-087-5.2.

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Alonso-Chamorro, María. "INTEGRAL MEDICINE WITH THE BUENAVENTURA FAMILY." In 15th International Conference on Education and New Learning Technologies. IATED, 2023. http://dx.doi.org/10.21125/edulearn.2023.0648.

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King, Jeremy, Jenenne Geske, Jared Marx, and Rachel Johnson. "AAA screening rates in Internal Medicine and Family Medicine at UNMC." In NAPCRG 52nd Annual Meeting — Abstracts of Completed Research 2024, 6239. American Academy of Family Physicians, 2024. http://dx.doi.org/10.1370/afm.22.s1.6239.

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Bulc, Mateja. "19 Guidelines and mindlines in family medicine." In Preventing Overdiagnosis Abstracts, December 2019, Sydney, Australia. BMJ Publishing Group Ltd, 2019. http://dx.doi.org/10.1136/bmjebm-2019-pod.125.

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Strenth, Chance, David Schneider, Usha Sambamoorthi, Sravan Mattevada, Kimberly Fulda, Bhaskar Thakur, and Anna Espinoza. "Harmonized Healthcare Database across Family Medicine Institutions." In NAPCRG 51st Annual Meeting — Abstracts of Completed Research 2023. American Academy of Family Physicians, 2023. http://dx.doi.org/10.1370/afm.22.s1.5404.

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Kaplan, Merve, Tugce Nur Berk, Bucra Cemrek, Sumeyye Sahin, and Ugur Fidan. "Mobile physiological signal monitoring system for family medicine." In 2017 Medical Technologies National Congress (TIPTEKNO). IEEE, 2017. http://dx.doi.org/10.1109/tiptekno.2017.8238029.

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Fredrickson, Erin. "Delivering Rural Obstetric Training for Family Medicine Residents." In NAPCRG 50th Annual Meeting — Abstracts of Completed Research 2022. American Academy of Family Physicians, 2023. http://dx.doi.org/10.1370/afm.21.s1.4136.

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Hashim, Ahmad Sobri, Mohammad Fahmi Mohd Yusoff, Aliza Sarlan, Saipunidzam Mahamad, and Shuib Basri. "Development of MyHomePharmacy: A personalized family medicine management." In 2016 3rd International Conference on Computer and Information Sciences (ICCOINS). IEEE, 2016. http://dx.doi.org/10.1109/iccoins.2016.7783285.

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Rapporti di organizzazioni sul tema "Family medicine"

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Gates, Timothy M. Quantitative Analysis of Contributing Factors Affecting Patient Satisfaction in Family Medicine Service Clinics at Brooke Army Medical Center. Fort Belvoir, VA: Defense Technical Information Center, June 2008. http://dx.doi.org/10.21236/ada493866.

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Bravo, David, Sergio Urzúa, and Claudia Sanhueza. Is There Labor Market Discrimination among Professionals in Chile?: Lawyers, Doctors and Businesspeople. Inter-American Development Bank, May 2008. http://dx.doi.org/10.18235/0011271.

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This paper analyzes gender differences in three Chilean professional labor markets, business, law and medicine, utilizing a new and rich data set collected for this purpose. The results show that differences in wages attributed to gender are only present in the legal profession. In business/economics, a vector of current family condition eliminates the gender effect and in Medicine, taking into account hours worked, size of firm and region also eliminates gender differences. The paper further shows that individuals' perceived locus of control (internal or external) is relevant in explaining the distribution of earnings.
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Woods, Rachel, Alison Zhong, and Madelyn Vincent. Factors Associated with Influenza & Tdap Vaccine Uptake in Pregnant Patients at the UT Family Medicine Clinic in Memphis. University of Tennessee Health Science Center, 2021. http://dx.doi.org/10.21007/com.lsp.2020.0003.

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INTRODUCTION: Given the increased risk for infections among pregnant patients and newborns, vaccination against influenza (>50,000,000 annual US cases affecting all ages) and pertussis (>15,000 annual US cases disproportionately affecting newborns) are recommended among pregnant patients in order to protect them and their babies via passive immunity to cover a newborn’s window of vaccine ineligibility. Though flu and Tdap vaccination rates among pregnant patients have been trending upwards nationally, there is still room for improvement to achieve optimal rates. OBJECTIVES: The primary objectives were to study factors that affect the vaccination rates at the University of Tennessee Family Medicine Clinic at Memphis (UTFMC-M), compare those rates with national pregnancy flu/Tdap vaccination rates, and to generate recommendations based off observed factors associated with vaccine uptake to improve flu/Tdap vaccination rates in UTFMC-M pregnant patients. METHODS: This was a retrospective chart review of UTFMC-M patients who were pregnant from September 1, 2019-April 24, 2020 (included 2019-2020 flu season) (n=465). Variables studied included demographic data (race, age, insurance), immunization history (vaccine status, history of physician encouragement), and prenatal history (parity, number of prenatal visits, trimester at first visit, high risk clinic (HRC) admittance status). Vaccination status was based on ACIP recommendations (Flu shot eligible = any gestational age; Tdap eligible = ≥27 weeks). Positive HRC admittance was noted for patients with ≥2 visits to the UTFMC-M HRC, a clinic that specializes in high risk pregnant patient care. RESULTS: The patient sample was predominantly black (84.3%) and insured by Medicaid programs (88%). Among eligible UTFMC-M pregnant patients, 50.1% were flu-vaccinated (n=465); 73.8% were Tdap-vaccinated (n=317); and 52.1% were Flu+Tdap-vaccinated (n=317). No significant associations were found between vaccine uptake and HRC status, parity, and age. However, statistically significant relationships were found between vaccine uptake and physician encouragement (positive relationship with flu shot: X2(1, N = 465) =131, p < 0.001, Tdap: X2 (6, N = 465) =476, p < 0.001), number of prenatal visits (flu shot group median 8 visits, Tdap group median 9 visits vs. unvaccinated group median 4 visits; p < 0.001), and early trimester age at first prenatal visit (X2(6, N = 465) =47.635 , p CONCLUSION: 2019-2020 UTFMC-M vaccination rates were on par with 2018-2019 US flu vaccine rates and higher than 2018-2019 US Tdap and Flu+Tdap rates. There were statistically significant relationships between vaccine uptake at UTFMC-M and physician encouragement, number of prenatal visits, and early trimester age at first prenatal visit but no significant relationships with UTFMC-M HRC admittance, parity, or age. Recommendations following from our observations to address further vaccine rate improvement include: continue vaccine encouragement, continue booking multiple visits (8 for flu, 9 for Tdap), prioritize Tdap vaccine higher for late trimester intake patients, and focus on flu vaccine encouragement and education.
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Huynh, Thao. Supplementary Materials - Adherence to the Canadian Cardiovascular Society Atrial Fibrillation Guidelines by Family Medicine Groups in Quebec: the I-FACILITER project. Science Repository, July 2019. http://dx.doi.org/10.31487/j.jicoa.2019.02.03.sup.

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Rancans, Elmars, Jelena Vrublevska, Ilana Aleskere, Baiba Rezgale, and Anna Sibalova. Mental health and associated factors in the general population of Latvia during the COVID-19 pandemic. Rīga Stradiņš University, February 2021. http://dx.doi.org/10.25143/fk2/0mqsi9.

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Description The goal of the study was to assess mental health, socio-psychological and behavioural aspects in the representative sample of Latvian general population in online survey, and to identify vulnerable groups during COVID-19 pandemic and develop future recommendations. The study was carried out from 6 to 27 July 2020 and was attributable to the period of emergency state from 11 March to 10 June 2020. The protocol included demographic data and also data pertaining to general health, previous self-reported psychiatric history, symptoms of anxiety, clinically significant depression and suicidality, as well as a quality of sleep, sex, family relationships, finance, eating and exercising and religion/spirituality, and their changes during the pandemic. The Center for Epidemiologic Studies Depression scale was used to determine the presence of distress or depression, the Risk Assessment of Suicidality Scale was used to assess suicidal behaviour, current symptoms of anxiety were assessed by the State-Trait Anxiety Inventory form Y. (2021-02-04) Subject Medicine, Health and Life Sciences Keyword: COVID19, pandemic, depression, anxiety, suicidality, mental health, Latvia
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Kriegel, Francesco. Learning description logic axioms from discrete probability distributions over description graphs (Extended Version). Technische Universität Dresden, 2018. http://dx.doi.org/10.25368/2022.247.

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Description logics in their standard setting only allow for representing and reasoning with crisp knowledge without any degree of uncertainty. Of course, this is a serious shortcoming for use cases where it is impossible to perfectly determine the truth of a statement. For resolving this expressivity restriction, probabilistic variants of description logics have been introduced. Their model-theoretic semantics is built upon so-called probabilistic interpretations, that is, families of directed graphs the vertices and edges of which are labeled and for which there exists a probability measure on this graph family. Results of scientific experiments, e.g., in medicine, psychology, or biology, that are repeated several times can induce probabilistic interpretations in a natural way. In this document, we shall develop a suitable axiomatization technique for deducing terminological knowledge from the assertional data given in such probabilistic interpretations. More specifically, we consider a probabilistic variant of the description logic EL⊥, and provide a method for constructing a set of rules, so-called concept inclusions, from probabilistic interpretations in a sound and complete manner.
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DiGrande, Laura, Christine Bevc, Jessica Williams, Lisa Carley-Baxter, Craig Lewis-Owen, and Suzanne Triplett. Pilot Study on the Experiences of Hurricane Shelter Evacuees. RTI Press, September 2019. http://dx.doi.org/10.3768/rtipress.2019.rr.0035.1909.

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Community members who evacuate to shelters may represent the most socially and economically vulnerable group within a hurricane’s affected geographic area. Disaster research has established associations between socioeconomic conditions and adverse effects, but data are overwhelmingly collected retrospectively on large populations and lack further explication. As Hurricane Florence approached North Carolina in September 2018, RTI International developed a pilot survey for American Red Cross evacuation shelter clients. Two instruments, an interviewer-led paper questionnaire and a short message service (SMS text) questionnaire, were tested. A total of 200 evacuees completed the paper survey, but only 34 participated in the SMS text portion of the study. Data confirmed that the sample represented very marginalized coastline residents: 60 percent were unemployed, 70 percent had no family or friends to stay with during evacuation, 65 percent could not afford to evacuate to another location, 36 percent needed medicine/medical care, and 11 percent were homeless. Although 19 percent of participants had a history of evacuating for prior hurricanes/disasters and 14 percent had previously utilized shelters, we observed few associations between previous experiences and current evacuation resources, behaviors, or opinions about safety. This study demonstrates that, for vulnerable populations exposed to storms of increasing intensity and frequency, traditional survey research methods are best employed to learn about their experiences and needs.
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MacFarlane, Andrew. 2021 medical student essay prize winner - A case of grief. Society for Academic Primary Care, July 2021. http://dx.doi.org/10.37361/medstudessay.2021.1.1.

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Abstract (sommario):
As a student undertaking a Longitudinal Integrated Clerkship (LIC)1 based in a GP practice in a rural community in the North of Scotland, I have been lucky to be given responsibility and my own clinic lists. Every day I conduct consultations that change my practice: the challenge of clinically applying the theory I have studied, controlling a consultation and efficiently exploring a patient's problems, empathising with and empowering them to play a part in their own care2 – and most difficult I feel – dealing with the vast amount of uncertainty that medicine, and particularly primary care, presents to both clinician and patient. I initially consulted with a lady in her 60s who attended with her husband, complaining of severe lower back pain who was very difficult to assess due to her pain level. Her husband was understandably concerned about the degree of pain she was in. After assessment and discussion with one of the GPs, we agreed some pain relief and a physio assessment in the next few days would be a practical plan. The patient had one red flag, some leg weakness and numbness, which was her ‘normal’ on account of her multiple sclerosis. At the physio assessment a few days later, the physio felt things were worse and some urgent bloods were ordered, unfortunately finding raised cancer and inflammatory markers. A CT scan of the lung found widespread cancer, a later CT of the head after some developing some acute confusion found brain metastases, and a week and a half after presenting to me, the patient sadly died in hospital. While that was all impactful enough on me, it was the follow-up appointment with the husband who attended on the last triage slot of the evening two weeks later that I found completely altered my understanding of grief and the mourning of a loved one. The husband had asked to speak to a Andrew MacFarlane Year 3 ScotGEM Medical Student 2 doctor just to talk about what had happened to his wife. The GP decided that it would be better if he came into the practice - strictly he probably should have been consulted with over the phone due to coronavirus restrictions - but he was asked what he would prefer and he opted to come in. I sat in on the consultation, I had been helping with any examinations the triage doctor needed and I recognised that this was the husband of the lady I had seen a few weeks earlier. He came in and sat down, head lowered, hands fiddling with the zip on his jacket, trying to find what to say. The GP sat, turned so that they were opposite each other with no desk between them - I was seated off to the side, an onlooker, but acknowledged by the patient with a kind nod when he entered the room. The GP asked gently, “How are you doing?” and roughly 30 seconds passed (a long time in a conversation) before the patient spoke. “I just really miss her…” he whispered with great effort, “I don’t understand how this all happened.” Over the next 45 minutes, he spoke about his wife, how much pain she had been in, the rapid deterioration he witnessed, the cancer being found, and cruelly how she had passed away after he had gone home to get some rest after being by her bedside all day in the hospital. He talked about how they had met, how much he missed her, how empty the house felt without her, and asking himself and us how he was meant to move forward with his life. He had a lot of questions for us, and for himself. Had we missed anything – had he missed anything? The GP really just listened for almost the whole consultation, speaking to him gently, reassuring him that this wasn’t his or anyone’s fault. She stated that this was an awful time for him and that what he was feeling was entirely normal and something we will all universally go through. She emphasised that while it wasn’t helpful at the moment, that things would get better over time.3 He was really glad I was there – having shared a consultation with his wife and I – he thanked me emphatically even though I felt like I hadn’t really helped at all. After some tears, frequent moments of silence and a lot of questions, he left having gotten a lot off his chest. “You just have to listen to people, be there for them as they go through things, and answer their questions as best you can” urged my GP as we discussed the case when the patient left. Almost all family caregivers contact their GP with regards to grief and this consultation really made me realise how important an aspect of my practice it will be in the future.4 It has also made me reflect on the emphasis on undergraduate teaching around ‘breaking bad news’ to patients, but nothing taught about when patients are in the process of grieving further down the line.5 The skill Andrew MacFarlane Year 3 ScotGEM Medical Student 3 required to manage a grieving patient is not one limited to general practice. Patients may grieve the loss of function from acute trauma through to chronic illness in all specialties of medicine - in addition to ‘traditional’ grief from loss of family or friends.6 There wasn’t anything ‘medical’ in the consultation, but I came away from it with a real sense of purpose as to why this career is such a privilege. We look after patients so they can spend as much quality time as they are given with their loved ones, and their loved ones are the ones we care for after they are gone. We as doctors are the constant, and we have to meet patients with compassion at their most difficult times – because it is as much a part of the job as the knowledge and the science – and it is the part of us that patients will remember long after they leave our clinic room. Word Count: 993 words References 1. ScotGEM MBChB - Subjects - University of St Andrews [Internet]. [cited 2021 Mar 27]. Available from: https://www.st-andrews.ac.uk/subjects/medicine/scotgem-mbchb/ 2. Shared decision making in realistic medicine: what works - gov.scot [Internet]. [cited 2021 Mar 27]. Available from: https://www.gov.scot/publications/works-support-promote-shared-decisionmaking-synthesis-recent-evidence/pages/1/ 3. Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers’ bereavement care practices: Recommendations for research directions. Int J Geriatr Psychiatry. 2014 Dec;29(12):1221–9. 4. Nielsen MK, Christensen K, Neergaard MA, Bidstrup PE, Guldin M-B. Grief symptoms and primary care use: a prospective study of family caregivers. BJGP Open [Internet]. 2020 Aug 1 [cited 2021 Mar 27];4(3). Available from: https://bjgpopen.org/content/4/3/bjgpopen20X101063 5. O’Connor M, Breen LJ. General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study. BMC Medical Education. 2014 Mar 27;14(1):59. 6. Sikstrom L, Saikaly R, Ferguson G, Mosher PJ, Bonato S, Soklaridis S. Being there: A scoping review of grief support training in medical education. PLOS ONE. 2019 Nov 27;14(11):e0224325.
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Leavy, Michelle B., Danielle Cooke, Sarah Hajjar, Erik Bikelman, Bailey Egan, Diana Clarke, Debbie Gibson, Barbara Casanova, and Richard Gliklich. Outcome Measure Harmonization and Data Infrastructure for Patient-Centered Outcomes Research in Depression: Report on Registry Configuration. Agency for Healthcare Research and Quality (AHRQ), November 2020. http://dx.doi.org/10.23970/ahrqepcregistryoutcome.

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Abstract (sommario):
Background: Major depressive disorder is a common mental disorder. Many pressing questions regarding depression treatment and outcomes exist, and new, efficient research approaches are necessary to address them. The primary objective of this project is to demonstrate the feasibility and value of capturing the harmonized depression outcome measures in the clinical workflow and submitting these data to different registries. Secondary objectives include demonstrating the feasibility of using these data for patient-centered outcomes research and developing a toolkit to support registries interested in sharing data with external researchers. Methods: The harmonized outcome measures for depression were developed through a multi-stakeholder, consensus-based process supported by AHRQ. For this implementation effort, the PRIME Registry, sponsored by the American Board of Family Medicine, and PsychPRO, sponsored by the American Psychiatric Association, each recruited 10 pilot sites from existing registry sites, added the harmonized measures to the registry platform, and submitted the project for institutional review board review Results: The process of preparing each registry to calculate the harmonized measures produced three major findings. First, some clarifications were necessary to make the harmonized definitions operational. Second, some data necessary for the measures are not routinely captured in structured form (e.g., PHQ-9 item 9, adverse events, suicide ideation and behavior, and mortality data). Finally, capture of the PHQ-9 requires operational and technical modifications. The next phase of this project will focus collection of the baseline and follow-up PHQ-9s, as well as other supporting clinical documentation. In parallel to the data collection process, the project team will examine the feasibility of using natural language processing to extract information on PHQ-9 scores, adverse events, and suicidal behaviors from unstructured data. Conclusion: This pilot project represents the first practical implementation of the harmonized outcome measures for depression. Initial results indicate that it is feasible to calculate the measures within the two patient registries, although some challenges were encountered related to the harmonized definition specifications, the availability of the necessary data, and the clinical workflow for collecting the PHQ-9. The ongoing data collection period, combined with an evaluation of the utility of natural language processing for these measures, will produce more information about the practical challenges, value, and burden of using the harmonized measures in the primary care and mental health setting. These findings will be useful to inform future implementations of the harmonized depression outcome measures.
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10

Leavy, Michelle B., Costas Boussios, Robert L. Phillips, Jr., Diana Clarke, Barry Sarvet, Aziz Boxwala, and Richard Gliklich. Outcome Measure Harmonization and Data Infrastructure for Patient-Centered Outcomes Research in Depression: Final Report. Agency for Healthcare Research and Quality (AHRQ), June 2022. http://dx.doi.org/10.23970/ahrqepcwhitepaperdepressionfinal.

Testo completo
Abstract (sommario):
Objective. The objective of this project was to demonstrate the feasibility and value of collecting harmonized depression outcome measures in the patient registry and health system settings, displaying the outcome measures to clinicians to support individual patient care and population health management, and using the resulting measures data to support patient-centered outcomes research (PCOR). Methods. The harmonized depression outcome measures selected for this project were response, remission, recurrence, suicide ideation and behavior, adverse effects of treatment, and death from suicide. The measures were calculated in the PRIME Registry, sponsored by the American Board of Family Medicine, and PsychPRO, sponsored by the American Psychiatric Association, and displayed on the registry dashboards for the participating pilot sites. At the conclusion of the data collection period (March 2020-March 2021), registry data were analyzed to describe implementation of measurement-based care and outcomes in the primary care and behavioral health care settings. To calculate and display the measures in the health system setting, a Substitutable Medical Apps, Reusable Technology (SMART) on Fast Healthcare Interoperability Resource (FHIR) application was developed and deployed at Baystate Health. Finally a stakeholder panel was convened to develop a prioritized research agenda for PCOR in depression and to provide feedback on the development of a data use and governance toolkit. Results. Calculation of the harmonized outcome measures within the PRIME Registry and PsychPRO was feasible, but technical and operational barriers needed to be overcome to ensure that relevant data were available and that the measures were meaningful to clinicians. Analysis of the registry data demonstrated that the harmonized outcome measures can be used to support PCOR across care settings and data sources. In the health system setting, this project demonstrated that it is technically and operationally feasible to use an open-source app to calculate and display the outcome measures in the clinician’s workflow. Finally, this project produced tools and resources to support future implementations of harmonized measures and use of the resulting data for research, including a prioritized research agenda and data use and governance toolkit. Conclusion. Standardization of outcome measures across patient registries and routine clinical care is an important step toward creating robust, national-level data infrastructure that could serve as the foundation for learning health systems, quality improvement initiatives, and research. This project demonstrated that it is feasible to calculate the harmonized outcome measures for depression in two patient registries and a health system setting, display the results to clinicians to support individual patient management and population health, and use the outcome measures data to support research. This project also assessed the value and burden of capturing the measures in different care settings and created standards-based tools and other resources to support future implementations of harmonized outcome measures in depression and other clinical areas. The findings and lessons learned from this project should serve as a roadmap to guide future implementations of harmonized outcome measures in depression and other clinical areas.
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