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Panda M Staton LJ Chen I Kurz J O'Rorke J Pasanen M Menon M Genao I Wood J Mechaber A Rosenberg E Faselis C Carey T Calleson D Cykert S 《The American journal of the medical sciences》2006,332(1):18-23
BACKGROUND: Chronic pain is a frequent cause of suffering and disability that seriously affects patients' quality of life and imposes a staggering socioeconomic toll on society. Little is known about the impact of patient-physician disagreement (discordance) regarding the assessment of chronic pain on patients' quality of life in primary care settings. This study evaluates the role of discordance and other potentially modifiable factors that affect the quality of life and functional status of chronic pain patients. METHODS: We evaluated 436 patient-physician encounters at 12 academic medical centers in the United States. We surveyed chronic nonmalignant pain patients to understand their pain perceptions. We concurrently surveyed their physicians about their perceptions of their patient's pain in primary care settings. RESULTS: More than 50% of physicians disagreed with their patient's pain. Thirty-nine percent of primary care physicians underestimated their patient's pain. In the multivariate analysis, this discordance was associated with poor physical functioning and worse bodily pain (P < 0.018 and P < 0.001 respectively). Patients with chronic, nonmalignant pain have reductions in physical function and bodily pain domains of the SF-36 compared to age-matched populations. Depression and obesity represented other associations. CONCLUSION: Patients with chronic nonmalignant pain have poor physical functioning and worse bodily pain. Discordance, obesity, and depression are other modifiable factors. Prospective studies are needed to design interventions. However, a multifaceted approach appears to represent the best opportunity to reduce the pain and suffering of this challenging population. 相似文献
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G. Carretero Hernández C. Ferrándiz R. Rivera Díaz E. Daudén Tello P. de la Cueva-Dobao F.J. Gómez-García E. Herrera-Ceballos I. Belinchón Romero J.L. López-Estebaranz M. Alsina Gibert J.L. Sánchez-Carazo M. Ferrán Farrés A. González Quesada J.M. Carrascosa Carrillo M. Llamas-Velasco M.V. Mendiola Fernández D. Ruiz Genao C. Muñoz Santos M.A. Descalzo 《Actas dermo-sifiliográficas》2018,109(7):617-623
Introduction and objectives
Biologic drugs are usually prescribed as second-line treatment for psoriasis, that is, after the patient has first been treated with a conventional psoriasis drug. There are, however, cases where, depending on the characteristics of the patient or the judgement of the physician, biologics may be chosen as first-line therapy. No studies to date have analyzed the demographics or clinical characteristics of patients in this setting or the safety profile of the agents used. The main aim of this study was to characterize these aspects of first-line biologic therapy and compare them to those observed for patients receiving biologics as second-line therapy.Material and method
We conducted an observational study of 181 patients treated in various centers with a systemic biologic drug as first-line treatment for moderate to severe psoriasis between January 2008 and November 2016. All the patients were registered in the Spanish Registry of Adverse Events Associated with Biologic Drugs in Dermatology.Results
The characteristics of the first- and second-line groups were very similar, although the patients receiving a biologic as first-line treatment for their psoriasis were older. No differences were observed for disease severity (assessed using the PASI) or time to diagnosis. Hypertension, diabetes, and liver disease were all more common in the first-line group. There were no differences between the groups in terms of reasons for drug withdrawal or occurrence of adverse effects.Conclusions
No major differences were found between patients with psoriasis receiving biologic drugs as first- or second-line therapy, a finding that provides further evidence of the safety of biologic therapy in patients with psoriasis. 相似文献7.
Angela Martinez-Strengel Lilanthi Balasuriya Aba Black David Berg Inginia Genao Cary P. Gross Danya Keene Darin Latimore Sylk Sotto-Santiago Dowin Boatright 《Journal of general internal medicine》2021,36(9):2539
BackgroundTo increase diversity and inclusion in graduate medical education, the Accreditation Council for Graduate Medical Education (ACGME) issued a revision to their Common Program Requirements during the 2019–2020 academic year mandating that all residency programs must have policies and practices to achieve appropriate diversity among trainees and faculty.ObjectiveTo explore the perspectives of internal medicine program directors (PDs) and associate program directors (APDs) on the ACGME diversity standard.DesignQualitative study of internal medicine residency program leadership from academic and community programs across the USA.ParticipantsCurrent PDs (n = 12) and APDs (n = 8) of accredited US internal medicine residency programs.ApproachWe conducted semi-structured, in-depth qualitative interviews. Data was analyzed using the constant comparative method to extract recurrent themes.Key ResultsThree main themes, described by participants, were identified: (1) internal medicine PDs and APDs had limited knowledge of the new Common Program Requirement relating to diversity; (2) program leaders expressed concern that the diversity standard reaches beyond the PDs’ scope of influence and lack of institutional commitment to the successful implementation of diversity standards; (3) participants described narrow view of diversity and inclusion efforts focusing on recruitment strategies during the interview season.ConclusionsOur findings of lack of familiarity with the new diversity standards, and limited institutional investment in diversity and inclusion efforts raise a concern about successful implementation across GME programs. Nevertheless, our finding suggests that structured implementation in the form of education, guideposts, and financial allocation can alleviate some of the concerns of program leadership in meeting the new ACGME diversity standard in a meaningful way.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06825-2.KEY WORDS: workforce diversity, Graduate Medical Education, diversity accreditation standards 相似文献
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Biopsychosocial Correlates of Binge Eating Disorder in Caucasian and African American Women with Obesity in Primary Care Settings
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Tomoko Udo Marney A. White Janet L. Lydecker Rachel D. Barnes Inginia Genao Rina Garcia Robin M. Masheb Carlos M. Grilo 《European eating disorders review》2016,24(3):181-186
This study examined racial differences in eating‐disorder psychopathology, eating/weight‐related histories, and biopsychosocial correlates in women (n = 53 Caucasian and n = 56 African American) with comorbid binge eating disorder (BED) and obesity seeking treatment in primary care settings. Caucasians reported significantly earlier onset of binge eating, dieting, and overweight, and greater number of times dieting than African American. The rate of metabolic syndrome did not differ by race. Caucasians had significantly elevated triglycerides whereas African Americans showed poorer glycaemic control (higher glycated haemoglobin A1c [HbA1c]), and significantly higher diastolic blood pressure. There were no significant racial differences in features of eating disorders, depressive symptoms, or mental and physical health functioning. The clinical presentation of eating‐disorder psychopathology and associated psychosocial functioning differed little by race among obese women with BED seeking treatment in primary care settings. Clinicians should assess for and institute appropriate interventions for comorbid BED and obesity in both African American and Caucasian patients. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. 相似文献
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Jada Bussey-Jones Lisa Bernstein Stacy Higgins David Malebranche Anuradha Paranjape Inginia Genao Bennett Lee William Branch 《Academic medicine》2006,81(7):674-679
In recent years, academic health centers have made a considerable effort to encourage medical students and physicians-in-training to consider academic medicine as a career choice. For physicians, selecting a career in academic medicine may be the first hurdle, but the challenge of successfully maintaining an academic career is perhaps a more formidable task. Mentoring is a much-needed response to this challenge. But the success of traditional mentoring programs at academic institutions is often limited by, among other things, the availability of senior faculty who can serve as mentors. The authors describe the formation and organization of the Internal Medicine Research Group at Emory (IMeRGE), an innovative peer mentoring group within the Division of General Medicine at Emory University. This group, born partially out of the mentoring needs of our women and minority faculty, shared the primary goal of fostering a collaborative atmosphere among junior faculty, while simultaneously acquiring experience through advanced faculty development. The authors present our methods of garnering division support for designated time and financial resources, defining member responsibilities, developing a curriculum, providing peer support, and seeking advisors with expertise in the areas on which we wished to focus. In addition to the development of IMeRGE, the authors provide an overview of the pros and cons of traditional mentoring versus peer mentoring; discuss the challenges faced by IMeRGE and strategies for addressing these issues; and present the paradigm of IMeRGE as a template for alternative forms of academic mentorship. 相似文献
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O'Rorke JE Chen I Genao I Panda M Cykert S 《The American journal of the medical sciences》2007,333(2):93-100
BACKGROUND: More than 100 million U.S. adults experience chronic nonmalignant pain. Many physicians are uncomfortable managing such patients. We sought to determine the timing and intensity of training that primary care physicians receive in chronic pain treatment, and the effect of training on their comfort in managing patients. METHODS: The 4P Study was a cross-sectional study conducted at 12 academic medical centers in the United States. More than 500 primary care physicians completed a survey regarding their attitudes toward patients with chronic nonmalignant pain and their education in chronic pain management. RESULTS: We received 572 surveys out of 753 distributed. The respondents' mean age was 35 years; 64% were white, non-Hispanic and 41% were women. Eighty-eight percent were internists, and mean years spent in practice were 7.6. Fifty-seven percent of the physicians felt that they should serve as the principal doctor managing patients with chronic nonmalignant pain. Only 34% of physicians felt comfortable in managing patients with chronic pain. More intensive education after entry into practice was associated with the highest comfort level. CONCLUSIONS: Most primary care physicians are not comfortable treating patients with chronic nonmalignant pain. Education increases primary care physicians' comfort in managing these patients. Increased comfort was associated with the willingness of primary care physicians to take charge of managing chronic pain. In addition, physician comfort is greatest when pain management skills are taught after residency training. 相似文献