RESUMO
Description Burnout is a prevalent and expensive problem in the US, and the National Plan For Health Workforce Well-Being included a goal to institutionalize well-being as a long-term value. Lifestyle Medicine (LM), an evidence-based practice using behavioral interventions to treat, prevent, and reverse certain chronic conditions, can achieve this goal. Implementing small changes in the workplace that support lifestyle medicine has a butterfly effect on both workplace and community well-being. Furthermore, the health of health care workers (HCWs) and patients improves, and health care costs decrease. This can be done with LM wellness programs or LM training for HCWs. LM wellness programs help the individual HCWs' and patients' well-being through the implementation of the 6 pillars of lifestyle medicine (nutrition, diet, stress reduction, social connection, avoiding/reducing toxins, restorative sleep) on an institutional level. LM initiatives, like LM training, help HCWs and their patients embark on this journey of optimal well-being, disease prevention, treatment, or reversal. Aligning policies to support evidence-based lifestyle changes that improve mood and stress reduction would support restorative rest, leaving HCWs less drained and allowing for more energy to be spent devoted to other lifestyle pillars. The Lifestyle Medicine Residency Curriculum is an example of an LM training program that leads to successful lifestyle change in residents' lives, improving their ability to coach patients. Finally, health care delivery that supports lifestyle medicine, such as shared medical appointments, is in alignment with the trend towards a value-based system for the improvement of public health.
RESUMO
Background: Proton pump inhibitors (PPI) have transformed the management of acid-related gastrointestinal disorders, becoming one of the top-selling medications in the United States. There is no doubt that PPIs have a significant therapeutic impact on patients with gastroesophageal reflux disease and gastrointestinal bleeding. However, evidence is mounting that PPIs are overprescribed, leading to more patients possibly experiencing adverse effects. There is a great deal of ongoing debate surrounding the significance and impact of these adverse effects. Methods: We conducted a study in 9 HCA hospitals in the southeastern United States to determine the number of patients who started on PPIs during their admission from July 2017 to July 2019 and, of these patients, how many were discharged on PPIs. We also explored whether PPIs were prescribed in conjunction with diagnoses consistent with appropriate use as defined by the National Institute for Health and Clinical Excellence (NICE) guidelines during their admissions. This appropriate use was evaluated based on ICD-10 codes entered during patient stays. Furthermore, we evaluated whether PPI patients had developed some known adverse effects including hypomagnesemia, pneumonia, and Clostridium difficile-associated diarrhea. Results: Our data showed that of the 52 712 patients included in the study, 53.1% (27 993) received PPIs without evidence of an appropriate diagnosis based on ICD-10 codes. Appropriate use ranged between 36.1% and 62.8% for each hospital included. Conclusion: PPIs were being overprescribed at the 9 hospitals included in the study according to the ICD-10 codes documented when compared to NICE guidelines. When compared with a normal, age-matched population, our results found increased rates of pneumonia and hypomagnesemia in patients being prescribed PPIs. This study suggests a need to improve hospital PPI prescribing practices to limit the non-indicated administration of PPIs and the resulting increased incidence of adverse effects.
RESUMO
Description On one of the busiest parkways, in the midst of a spring drought, despite the lack of soil a sunflower blooms. This tiny beacon of hope represents the enduring spirit of humanity managing to struggle through this recent global pandemic. For me as a program director, it conjures to mind my graduating family medicine residents. Due to COVID-19, they had to pull extra shifts in the hospital, flip patients in the ICU, and witnessed death on an unprecedented scale. Despite this adversity, they continue to grow professionally, thrive individually, and show the world their sunny smiling faces.
RESUMO
Description Community health is vital to increase the lifespan and quality of life of the people on our planet. We must unite to fight disease through education and implementing quality healthcare. This piece was created prior to the pandemic, but its message is so incredibly pertinent in these troubling times. We must encourage patients and one another to take precautions such as wearing masks and getting vaccines in order to reduce the morbidity and mortality of COVID-19.
RESUMO
Description Cutaneous malignant melanoma (CMM) is a condition wherein malignant cells form in the melanocytic cells. CMM is a potentially lethal form of skin cancer, commonly found in sun-exposed areas of the body. There are multiple risk factors for disease development, such as genetic mutation and UV radiation among others. Diagnosis and staging is important in determining disease morbidity and mortality. The United States Preventive Services Task Force (USPSTF) and the American Academy of Dermatology (AAD) have their respective guidelines and consensus on diagnosis, staging and treatment. It is imperative to delineate and educate primary care physicians on CMM, as they serve as the first line of defense in disease diagnosis. The purpose of this article is to provide a concise educational synopsis for primary care physicians.
