Copyright (c) 2009 Thomas Jefferson University All rights reserved. http://jdc.jefferson.edu/fmfp Recent documents in Department of Family & Community Medicine Faculty Papers en-us Fri, 04 Dec 2009 03:24:17 PST 3600 http://jdc.jefferson.edu/fmfp/21 http://jdc.jefferson.edu/fmfp/21 Wed, 02 Dec 2009 07:23:21 PST OBJECTIVES: The Emilia-Romagna region of Italy has reduced the number of available hospital beds and introduced financial incentives to curb hospital use. The goal of this study was to assess the impact of these policies on changes over time in the number of acute hospital admissions classified in diagnosis related groups (DRGs) that could be treated safely and effectively in alternative, less costly settings. METHODS: The assessment of the appropriate site of care was based on analysis of hospital discharge data for all hospitals for the selected diagnosis related groups in the Emilia-Romagna region for 2001 to 2005. The necessity for acute hospital admission was based on the severity of a patient's principal diagnosis, co-morbid diseases and, for surgical admissions, procedure performed. RESULTS: From 2001 to 2005, potentially inappropriate medical admissions of more than one day decreased from 20,076 to 11,580, a 42% decrease. Inappropriate admissions decreased in both public and private hospitals but there remained a higher rate of inappropriate admissions to private hospitals. Potentially inappropriate medical admissions accounted for 128,319 bed-days in 2001 and 68,968 bed-days in 2005, a reduction of 59,351 bed-days. Potentially inappropriate surgical admissions decreased from 7383 in 2001 to 4349 in 2005, a 41% decrease. Bed-days consumed by inappropriate surgical admissions decreased from 23,181 in 2001 to 13,660 in 2005. CONCLUSIONS: The Emilia-Romagna region has succeeded in reducing the use of acute hospital beds for patients in selected diagnosis related groups. However, there are still substantial numbers of admissions that could potentially be treated in less costly settings. Daniel Louis Adolescent Adult Aged Diagnosis-Related Groups Health Policy Health Services Hospitalization Humans Italy Medical Audit Middle Aged Needs Assessment Young Adult http://jdc.jefferson.edu/fmfp/20 http://jdc.jefferson.edu/fmfp/20 Mon, 16 Nov 2009 07:51:53 PST Edward M. Kennedy, the long-serving senior senator from Massachusetts who died on August 25, 2009, had a major impact on Americans who deliver or receive health care services and left a vast legacy to our health care system. Kennedy arrived in Congress in 1963 with a dedication to fairness, justice, and equal opportunity and a deep well of personal commitment and energy. He brought his values to bear on the policy areas of his Senate committee assignments, one of which was Health, Education, Labor, and Pensions. The result was an unswerving devotion to universal access to health care, enhanced education for health professionals, biomedical research and research ethics, and public health. Mona Sarfaty Delivery of Health Care Education, Medical, Graduate Famous Persons Federal Government History, 20th Century History, 21st Century Humans National Institutes of Health (U.S.) Politics Public Health United States http://jdc.jefferson.edu/fmfp/19 http://jdc.jefferson.edu/fmfp/19 Mon, 16 Nov 2009 07:45:27 PST Climate change will have an effect on the health and well-being of the populations cared for by practicing physicians. The anticipated medical effects include heat- and cold-related deaths, cardiovascular illnesses, injuries and mental harms from extreme weather events, respiratory illnesses caused by poor air quality, infectious diseases that emanate from contaminated food, water, or spread of disease vectors, the injuries caused by natural disasters, and the mental harm associated with social disruption. Within several years, such medical problems are likely to reach the doorsteps of many physicians. In the face of this reality, physicians should assume their traditional roles as medical professionals, health educators, and community leaders. Clinicians provide individual health services to patients, some of whom will be especially vulnerable to the emerging health consequences of global warming. Physicians also work in academic medical institutions and hospitals that educate and provide continuing medical education to students, residents, and practitioners. The institutions also produce a measurable carbon footprint. Societies of physicians at national, state, and local levels can choose to use their well-developed avenues of communication to raise awareness of the key issues that are raised by climate change as well as other environmental concerns that have profound implications for human health and well-being. Mona Sarfaty Communicable Diseases Conservation of Energy Resources Disasters Greenhouse Effect Humans Physician's Role Population Surveillance Public Policy http://jdc.jefferson.edu/fmfp/18 http://jdc.jefferson.edu/fmfp/18 Thu, 05 Nov 2009 10:45:31 PST The emotional investment required to construct a caring doctor-patient relationship can be justified on humane grounds. Can it also be justified as a direct physiologic intervention? Two lines of evidence point in this direction. People in an empathic relationship exhibit a correlation of indicators of autonomic activity. This occurs between speakers and responsive listeners, members of a coherent group, and bonded pairs of higher social animals. Furthermore, the experience of feeling cared about in a relationship reduces the secretion of stress hormones and shifts the neuroendocrine system toward homeostasis. Because the social engagement of emotions is simultaneously the social engagement of the physiologic substrate of those emotions, the process has been labeled sociophysiology. This process can influence the health of both parties in the doctor-patient relationship, and may be relevant to third parties. Herbert M. Adler http://jdc.jefferson.edu/fmfp/17 http://jdc.jefferson.edu/fmfp/17 Thu, 27 Aug 2009 12:42:03 PDT Obesity has become the second leading preventable cause of disease and death in the United States, trailing only tobacco use. Weight control, dietary choices, and levels of physical activity are important modifiable determinants of cancer risk. If multi-factorial approaches to prevention and management are not implemented, obesity will likely become the leading modifiable cause of death in the coming years. Physicians have a key role in integrating these approaches into clinical care and advocating for systemic prevention efforts. This article provides: 1) an introduction to the epidemiology and magnitude of childhood and adult obesity; 2) the relationship of overweight/obesity to cancer and other chronic diseases, 3) potential mechanisms postulated to explain these relationships; 4) a review of recommended obesity treatment and assessment guidelines for adults, adolescents and children: 5) multi-level prevention strategies, and; 6) an approach to obesity management in adults utilizing the Chronic Care Model. Rickie Brawer, PhD, MPH http://jdc.jefferson.edu/fmfp/16 http://jdc.jefferson.edu/fmfp/16 Wed, 01 Jul 2009 11:54:40 PDT A 62yo white male presented to same day clinic with an erythematous nodular rash. He was initially treated with antibiotics for a furunculosis, but the rash worsened and he was eventually found to have secondary syphilis. He is an MSM who had a prior history of syphilis, putting him at high risk for STI's and HIV, and should have been undergoing annual screening. He was found to be HIV positive. The rates of STI's and HIV are increasing in older Americans. Despite this, physicians do not regularly screen this population for unsafe sexual behavior. This case emphasizes the importance of taking a sexual history in older patients, assessing their risk for STI's and HIV, and providing them with education about safe sex. Daniel DeJoseph, MD http://jdc.jefferson.edu/fmfp/15 http://jdc.jefferson.edu/fmfp/15 Wed, 04 Feb 2009 10:16:34 PST Angioedema is a side effect that is often associated with use of angiotensin converting enzyme inhibitor medications. These medications result in increased levels of circulating bradykinins. This case illustrates the result of a local traumatic event to the upper lip, presumably causing marked bradykinin release in a patient who was taking an ACE-inhibitor. The local release of bradykinin from trauma, in addition to decreased bradykinin catabolism secondary to ACE-inhibitor therapy resulted in angioedema predominantly in the upper lip. The angioedema resolved with discontinuation of the ACE-inhibitor. B. B. Simmons http://jdc.jefferson.edu/fmfp/14 http://jdc.jefferson.edu/fmfp/14 Wed, 13 Feb 2008 07:12:10 PST Complexity theory has been used to view the patient-physician relationship as constituted by complex responsive processes of relating. It describes an emergent, psychosocial relational process through which patients and physicians continually and reciprocally influence each other's behavior and experience. As psychosocial responses are necessarily biopsychosocial responses, patients and physicians must likewise be influencing each other's psychobiology. This mutual influence may be subjectively experienced as empathy, and may be skillfully employed by the clinician to directly improve the patient's psychobiology. Herbert M. Adler http://jdc.jefferson.edu/fmfp/13 http://jdc.jefferson.edu/fmfp/13 Thu, 17 Jan 2008 13:18:21 PST The relationships, interactions, and association between obesity and asthma are complex, and are active sources of hypotheses and research. An association between obesity and asthma has been reported in many studies, although considerable debate about the existence of the association and its meaning still exists. Potential associative relationships may result from genetics, immune system modifications, and mechanical mechanisms. The rising prevalence of asthma and obesity in children and adults, and the significant morbidity from both, makes it imperative that clinicians recognize the importance of weight management in patients with and without asthma. James Plumb http://jdc.jefferson.edu/fmfp/12 http://jdc.jefferson.edu/fmfp/12 Fri, 26 Oct 2007 10:51:29 PDT The sudden appearance of a pruritic confluent erythematous rash on the anterior neck and upper back prompted a 30-year-old woman to seek medical attention. She had recently started applying 5% tea tree oil to the area to treat chronic, recurrent tinea versicolor. An herbal specialist had recommended this therapy.