The toxicity of methotrexate in male fertility and paternal teratogenicity.

There is a high prevalence of methotrexate (MTX) use in males of reproductive age. The scope of this paper reviews what is known regarding risks to fertility and partners' pregnancy outcomes with regard to MTX use in men. Areas covered: This paper reviews the evidence for current recommendations for MTX use and male fertility and aims to educate professionals regarding MTX use in reproducing males so that patients may be counseled appropriately.

Characterizing Primary Care Visit Activities at Veterans Health Administration Clinics.

Medical home models seek to increase efficiency and maximize the use of resources by ensuring that all care team members work at the top of their licenses. We sought to break down primary care office visits into measurable activities to better under stand how primary care providers (PCPs) currently spend visit time and to provide insight into potential opportunities for revision or redistribution of healthcare tasks. We videotaped 27 PCPs during office visits with 121 patients at four Veterans Health Administration medical centers.

Rethinking primary care visits: how much can be eliminated, delegated or performed outside of the face-to-face visit?

Rationale, Aims And Objectives: Office visits represent the core component of primary care practice, but little is known about what percentage of primary care provider (PCP) visit time could be suitable for reassignment to another medical home team member or to a non-face-to-face modality (e.g. secure messaging) in order to optimize face-to-face PCP visit time.

Racial differences in expectations of joint replacement surgery outcomes.

Objective: Prior studies have indicated racial differences in patients' expectations for joint replacement surgery outcomes. The goal of this study was to measure these differences using a well-validated survey instrument and to determine if the differences could be explained by racial variation in disease severity, socioeconomic factors, literacy, or trust.

Methods: Detailed demographic, clinical, psychological, and social data were collected from 909 male patients (450 African American, 459 white) ages 50-79 years with moderate or severe osteoarthritis (OA) of the hip or knee receiving primary care at 2 veterans affairs medical centers.