Utilizing a Referral-Based Procedure Clinic Rotation in Family Medicine Residency.

Introduction: Performing clinical procedures is an essential component of family medicine (FM) residency training. A referral-based procedure clinic was established at our institution in 2014, and a yearly 2-week rotation was established for residents. The objective of this study was to determine the effect of a procedure clinic rotation on the numbers of procedures performed during residency training. Methods: We conducted a retrospective review on graduating FM residents from 2009 to 2019. Data collected include type and number of procedures performed each postgraduate year. We analyzed data as mean number of procedures per resident per year. We conducted statistical comparison with Wilcoxon-Mann-Whitney two-sample rank-sum tests. Results: Residents who participated in the procedure clinic rotation performed significantly more dermatologic procedures per year, joint and soft tissue injections and intrauterine device (IUD) insertions and removals, but did not perform significantly more circumcisions, endometrial biopsies, incision and drainages, subdermal contraceptive implant procedures, toenail removals, or vasectomies. Conclusion: The establishment of a 2-week procedure clinic rotation for FM residents was associated with a significant increase in dermatologic procedures, joint and soft tissue injections, and IUD procedures. Further research can explore the impact of this rotation on procedural competency and confidence.

Pre-Anesthetic Medical Evaluations: Criteria Considerations for Telemedicine Alternatives to Face to Face Visits.

BACKGROUND: The number of pre-anesthetic medical evaluations (PAMEs) being conducted in primary care is increasing. Due to the COVID-19 pandemic, the use of telemedicine has surged, providing a feasible way to conduct some of these visits. This study aimed to identify patient-related factors where a face to face (FTF) evaluation is indicated, measured by the need for pre-operative testing. METHODS: A retrospective chart review was conducted on patients age ≥ 18 years who had a PAME between January 2019-June 2020 at a rural primary care clinic in Southeast Minnesota. Data collected included age, gender, Charlson Comorbidity Index Score, medications, revised cardiac risk index (RCRI), smoking status, exercise capacity, body mass index, and pre-operative testing. Logistical regression modeling for odds ratios of outcomes was performed. RESULTS: 254 patients were included, with an average age of 64.1 years; 43.7% were female. Most were obese (mean BMI 31.6), non-smoking (93.7%) with excellent functional capacity (87.8% ≥ 5 METs). 76.8% of the planned surgeries were intermediate or high risk. 35.0% (n = 89) of visits resulted in medication adjustments and 76.7% (n = 195) in pre-operative testing. Age ≥ 65 years, ≥7 current medications, and diabetes all significantly increased the odds of requiring pre-operative testing (P < .05). CONCLUSIONS: This study was able to identify patient-related factors that increased the likelihood of requiring pre-operative testing. Patients who are age ≥ 65 years, ≥7 current medications, and those with diabetes could be scheduled for a FTF evaluation. Others could be scheduled for a telemedicine visit to minimize health-care exposures.

A Case of Anaplasmosis during a Warm Minnesota Fall.

A healthy 33 year old male presented in December with a 3 week history of fever and fatigue. He had been deer-hunting in northern Minnesota 1 month prior and had sustained a tick bite. Extensive laboratory investigations and a lumbar puncture were conducted. He was empirically with doxycycline and had rapid improvement in his symptoms. Subsequently, PCR and serologic testing returned positive for Anaplasma phagocytophlium. Anaplasmosis is a tick-borne illness caused by the bacterium Anaplasma phagocytophilum and is typically seen in the warmer months. This patient's presentation in December was uncommon for a tick-borne illness in Minnesota. Regional weather records demonstrated unseasonably warm temperatures during the patient's trip. Ixodes ticks are known to be sensitive to temperature and humidity, which likely contributed to increased tick activity, leading to disease transmission. This case highlights the importance for clinicians to be aware of local weather patterns and how this might influence seasonal disease presentations.

Prevalence and ethnic variation of pre-auricular sinuses in children.

OBJECTIVES: Pre-auricular sinus (PAS) describes a congenital ear malformation presenting as a pit or sinus that may become infected, often requiring antibiotics and/or surgical excision. Although the presentation of PAS in otolaryngology clinics is not uncommon, there is limited epidemiological data regarding this malformation in children. Some evidence also suggests a potential ethnic variation in prevalence rates and potential heritability patterns within families, however these have yet to be proven. This study is the first to use pediatric population level data to investigate prevalence rate, ethnic variation, and to explore the unproven hypotheses of a genetic basis of PAS. METHODS: In this prospective cross-sectional study, we enrolled 1106 subjects (mean age=6.8, male-to-female ratio=1.15:1) between June and September 2014. Subjects were recruited from B.C. Children's Hospital in Vancouver, Canada. Inclusion criteria was children <18 years of age; exclusion criteria was those seeking care for PAS. Subjects were visually inspected for the presence of PAS by clinical observers followed by verbal questionnaire (demographics, self-identified ethnicity, family history of PAS, chronic medical conditions). Data analysis utilized Pearson Chi-Square Test to determine the potential ethnic variation, and odds ratios of family history were used to determine a potential genetic basis. RESULTS: 26 (7 bilateral, 19 unilateral) of 1106 subjects were positive for PAS (2.4%). Using Pearson Chi-Square Test, a significant ethnic variation was found to exist (χ(2) (6,N=1106)=22.80, p<0.0001), with Asians having the highest prevalence (6.6%), followed by African Americans (4.5%), Middle Easterners (3.4%), First Nations (2.0%), and Caucasians (1.2%). None were found in South Asians (n=124) or Latin Americans (n=18). Subjects with positive family history of PAS had greater likelihood of having PAS (OR=16.7, 95% CI=7.3-38.5, p<0.0001). There was also stronger association between family history and bilateral PAS (OR=26.5, 95% CI=5.8-121.7, p<0.0001) compared to unilateral PAS (OR=12.2, 95% CI=4.6-32.5, p<0.0001). CONCLUSIONS: This was the largest pediatric population level study to date, and showed the prevalence of PAS was 2.4% in this pediatric population, whose ethnic diversity was representative of B.C.'s community. A significant ethnic variation existed and associations between family history and PAS suggested a potential genetic basis, particularly with bilateral PAS.