Telehealth examination of the lumbar spine.

BACKGROUND: Telehealth evaluations of musculoskeletal conditions have increased due to the stay-at-home policies enacted during the COVID-19 pandemic. Back pain is one of the most common complaints in primary care. While telehealth may never supplant in-person evaluation of back pain, it is imperative in a changing world to learn to perform this evaluation via telephone or video. Virtual visits rely on history-taking and patient self-reported descriptions of pain elicited from self-palpation or specific movements while on the telephone with the clinician. Video examinations provide a unique way of evaluating the lower back compared to telephone because of the ability to visualize the actions of the patient. OBJECTIVE: To create an evaluation pathway for examination of the lumbar spine via telehealth. METHODS: Our group has created a step-by-step evaluation pathway to help physicians direct their patients through typical lumbar examination elements, including inspection, palpation, range of motion, and strength, special, and functional testing. RESULTS: We have developed a table of questions and instructions and a glossary of images of each maneuver to facilitate lumbar spine examination via telemedicine. CONCLUSIONS: This paper provides a guide for extracting clinically relevant information while performing telemedicine examinations of the lumbar spine.

Professionalism and inter-communication skills (ICS): a multi-site validity study assessing proficiency in core competencies and milestones in medical learners.

BACKGROUND: Interpersonal and Communication Skills (ICS) and Professionalism milestones are challenging to evaluate during medical training. Paucity in proficiency, direction and validity evidence of assessment tools of these milestones warrants further research. We validated the reliability of the previously-piloted Instrument for Communication skills and Professionalism Assessment (InCoPrA) in medical learners. METHODS: This validity approach was guided by the rigorous Kane's Framework. Faculty-raters and standardized patients (SPs) used their respective InCoPrA sub-component to assess distinctive domains pertinent to ICS and Professionalism through multiple expert-built simulated-scenarios comparable to usual care. Evaluations included; inter-rater reliability of the faculty total score; the correlation between the total score by the SPs; and the average of the total score by two-faculty members. Participants were surveyed regarding acceptability, realism, and applicability of this experience. RESULTS: Eighty trainees and 25 faculty-raters from five medical residency training sites participated. ICC of the total score between faculty-raters was generally moderate (ICC range 0.44-0.58). There was on average a moderate linear relationship between the SPs and faculty total scores (Pearson correlations range 0.23-0.44). Majority of participants ascertained receiving a meaningful, immediate, and comprehensive patient-faculty feedback. CONCLUSIONS: This work substantiated that InCoPrA was a reliable, standardized, evidence-based, and user-friendly assessment tool for ICS and Professionalism milestones. Validating InCoPrA showed generally-moderate agreeability and high acceptability. Using InCoPrA also promoted engaging all stakeholders in medical education and training-faculty, learners, and SPs-using simulation-media as pathway for comprehensive feedback of milestones growth.

Primary Care Perceptions and Practices on Discussion and Advice Regarding Sexual Practices.

OBJECTIVES: The United States has experienced an increase in sexually transmitted infections (STIs) in the past decade, a trend that may be influenced by communication gaps between family physicians and patients. We sought to identify factors that hinder discussion about safe sexual practices and STIs, understand physicians' perceptions of their role in preventing STIs, and explore methods of initiating discussions on sexual health. METHODS: From April 30, 2016 to September 1, 2016, family physicians at our institution were given written surveys with 22 questions to answer and rank in order of their best practice. The survey assessed participants' age, sex, level of medical education, and possible barriers to initiating discussion and offering advice on safe sexual practices. RESULTS: All of the participants identified time constraints and the presence of a patient's spouse, parents, or siblings as the most common barriers. Other barriers included fear of embarrassing patients and feeling inadequately knowledgeable about the sexual practices of lesbian, bisexual, gay, and transgender patients. All of the participants reported that patients rarely object to discussing sexual behaviors. CONCLUSIONS: Our study identified several barriers that family physicians may face when initiating discussions and advising patients on safe sexual practices. To prevent new cases of STIs, it is important to work around these barriers to improve physician-patient communication. This can be further improved by providing continuous learning opportunities for medical students, residents, and board-certified family physicians on ways to appropriately counsel patients on safe sexual practices.

Patient-Centered Medical Home With Colocation: Observations and Insights From an Academic Family Medicine Clinic.

There is a movement in the United States to transform family medicine practices from single physician-based patient care to team-based care. These teams are usually composed of multiple disciplines, including social workers, pharmacists, registered nurses, physician assistants, nurse practitioners, and physicians. The teams support patients and their families, provide holistic care to patients of all ages, and allow their members to work to the highest level of their training in an integrated fashion. Grouping care team members together within visual and auditory distance of each other is likely to enhance communication and teamwork, resulting in more efficient care for patients. This grouping is termed colocation. The authors describe how the use of colocation can lead to clearer, faster communication between care team members. This practice style has the potential to be expanded into various clinical settings in any given health system and to almost all clinical specialties and practices.

Urinary Tract Infection Antibiotic Resistance in the United States.

Urinary tract infection (UTI) is one of the most common entities in medicine and affected patients present daily in a typical family medicine practice. The patients often present with the "classic symptoms" of dysuria and increased frequency, but sometimes they are asymptomatic or have a mixed picture. In most cases, an antibiotic is prescribed, and this practice is likely contributing to increasing worldwide antibiotic resistance. To help combat this problem, it is important that clinicians seek out their local bacterial resistance patterns and antibiograms, properly diagnose and treat UTI if indicated, and recognize their role in antibiotic stewardship.

Henoch-Schönlein purpura: a review article.

Henoch-Schönlein purpura (HSP) is the most common vasculitis of childhood. Although HSP is typically a disease of children, adult cases have been described. HSP can affect multiple organs with a characteristic rash present in all patients. Most cases resolve with symptomatic treatment, but serious complications can occur such as renal failure. Primary care physicians should be well aware of the disease because the true incidence is probably underestimated.