Cost Analysis of Integrated Behavioral Health in a Large Primary Care Practice.

A residency-based Family Medicine outpatient clinic chose to implement an integrated behavioral health care program in a large primary care clinic in the Southeast to improve patient access to behavioral health care. We hypothesized that embedding a BHP in a primary care setting would be a cost neutral intervention. We implemented a prospective cohort design and included expenses from both inpatient and outpatient visits.

Comparing telehealth to traditional office visits for patient management in the COVID-19 pandemic: A cross-sectional study in a respiratory assessment clinic.

Introduction: The aim of this study was to examine whether telehealth is as safe and effective as traditional office visits in assessing and treating patients with symptoms consistent with COVID-19.

Methods: In this retrospective cross-sectional study, the primary outcome was any 14-day related healthcare follow-up event(s). Secondary outcomes were the type of 14-day related follow-up event including hospital admission, emergency department visit, office visit, telehealth visit and/or multiple follow-up visits.

Patient experience of an integrated care model in a family practice clinic & FQHC.

In order to investigate the patient experience of integrated behavioral health care in primary care settings, we implemented a patient cohort model from a combined site sample (N = 727) consisting of a family practice clinic and a Federally Qualified Health Center. Patient experience was measured using 12 questions from a validated measure, the Agency for Healthcare Research and Quality's Consumer Assessment of Health Care Providers and Systems (CAHPS®), Home and Community Based Services version, and six additional questions about interactions with an integrated behavioral health care team. We assessed bivariate relationships between satisfaction with integration and the clinic practice and self-reported physical health or self-reported mental/emotional health.

Group Medical Visit Training in Family Medicine Residency: A 2015 CERA Program Directors Survey.

Background And Objectives: Group medical visits (GMV) have been shown to improve clinical outcomes and patient satisfaction and are included as a new tool in the patient-centered medical home (PCMH). The capacity for and interest in developing GMV skills in family medicine residency have not been assessed. This study aims to describe the extent of existing training in GMV as well as attitudes toward and barriers to this training.

Using Standardized Patient Assessments to Evaluate a Health Literacy Curriculum.

Background And Objectives: Patients' health literacy is a growing concern as patients are expected to perform more self-care. While many US schools implement health literacy in their curricula, time spent on the topic ranges from 0 to 8 hours and is largely didactic. Evaluation of health literacy skills is not well defined.

Implementing the Bruker MALDI Biotyper in the Public Health Laboratory for C. botulinum Neurotoxin Detection.

Currently, the gold standard method for active botulinum neurotoxin (BoNT) detection is the mouse bioassay (MBA). A Centers for Disease Control and Prevention-developed mass spectrometry (MS)-based assay that detects active BoNT was successfully validated and implemented in a public health laboratory in clinical matrices using the Bruker MALDI-TOF MS (Matrix-assisted laser desorption ionization-time of flight mass spectrometry) Biotyper. For the first time, a direct comparison with the MBA was performed to determine MS-based assay sensitivity using the Bruker MALDI Biotyper.

Medical student attitudes toward the medically underserved: the USU perspective.

This study examined a cohort of students attending the Uniformed Services University regarding their attitudes toward medical care in underserved populations. Using the previously validated Medical Student Attitudes Toward the Underserved (MSATU), repeated measures analysis of variance showed that student attitudes toward care in underserved populations was less favorable than limited national data at entry and declined over time (Mean MSATU total score Year 1: 46.2 [SD 10.

Two cases of adult botulism caused by botulinum neurotoxin producing Clostridium baratii.

Type F botulism occurs rarely in clinical cases. Two cases of type F botulism in elderly patients that were clustered in time and space are described. Clostridium baratii producing type F botulinum neurotoxin was isolated from both patients; molecular typing of these isolates revealed that they were unrelated strains.

Are medical students aware of their anti-obesity bias?

Purpose: Anti-obesity prejudices affect the quality of care obese individuals receive. The authors sought to determine the prevalence of weight-related biases among medical students and whether they were aware of their biases.

Method: Between 2008 and 2011, the authors asked all third-year medical students at Wake Forest School of Medicine to complete the Weight Implicit Association Test (IAT), a validated measure of implicit preferences for "fat" or "thin" individuals.

Standardized patient instructors' and physician assistant students' evaluation of diabetes counseling skills.

Purpose: Standardized patient instructors (SPIs) have been used in medical and physician assistant (PA) teaching and have been shown to be a valuable resource for assessing interviewing and clinical skills. This study evaluated the agreement between SPI ratings and student self-ratings in the assessment of counseling skills.

Methods: PA students in three graduating classes (2009-2011) participated in this study.

Characteristics associated with glycemic control among family medicine patients with type 2 diabetes.

Background: As new payment models are developed for chronic diseases such as diabetes, there is a need to understand which patient characteristics impact glycemic control. This study examines the relationship between patient variables and glycemic control, defined as a hemoglobin A1c (A1c) level of <7%, in a cohort of family medicine patients with type 2 diabetes.

Methods: A total of 1,398 medical charts were selected using International Classification of Diseases, Ninth Revision, Clinical Modification codes for diabetes.

Analysis of Clostridium botulinum serotype E strains by using multilocus sequence typing, amplified fragment length polymorphism, variable-number tandem-repeat analysis, and botulinum neurotoxin gene sequencing.

A total of 41 Clostridium botulinum serotype E strains from different geographic regions, including Canada, Denmark, Finland, France, Greenland, Japan, and the United States, were compared by multilocus sequence typing (MLST), amplified fragment length polymorphism (AFLP) analysis, variable-number tandem-repeat (VNTR) analysis, and botulinum neurotoxin (bont) E gene sequencing. The strains, representing environmental, food-borne, and infant botulism samples collected from 1932 to 2007, were analyzed to compare serotype E strains from different geographic regions and types of botulism and to determine whether each of the strains contained the transposon-associated recombinase rarA, involved with bont/E insertion. MLST examination using 15 genes clustered the strains into several clades, with most members within a cluster sharing the same BoNT/E subtype (BoNT/E1, E2, E3, or E6).

Hidden in plain sight: residency coordinators' social support of residents in family medicine residency programs.

Background And Objectives: Social support resources for family medicine residents have increased over the years in response to the challenges of residency training and Accreditation Council for Graduate Medical Education (ACGME) requirements. In all of the discussions of social support, the role of residency coordinators (RCs) has been overlooked. A national survey was conducted to expose and explore the contribution of RCs to the social support of family medicine residents.

Estimation of injury simulation in international women's football.

This study attempted to determine the frequency of apparent injury incidents in women's international football and estimate what proportion was authentic. Broadcast recordings of 47 games from 2 tournaments were reviewed to identify incidents in which a player behaved as if injured. Apparent injuries were considered definite if a player withdrew from participation within 5 minutes or if bleeding was visible.

Issues encountered by physicians during international travel with youth national soccer teams.

Background: Little information is available to guide the selection, preparation, and support of a traveling team physician.

Purpose: To determine the types of injuries and medical problems, as well as general team health and performance issues, encountered by physicians traveling internationally with youth national soccer teams.

Study Design: Descriptive epidemiology.

Biodiversity of Clostridium botulinum type E associated with a large outbreak of botulism in wildlife from Lake Erie and Lake Ontario.

The genetic relatedness of Clostridium botulinum type E isolates associated with an outbreak of wildlife botulism was studied using random amplification of polymorphic DNA (RAPD). Specimens were collected from November 2000 to December 2008 during a large outbreak of botulism affecting birds and fish living in and around Lake Erie and Lake Ontario. In our present study, a total of 355 wildlife samples were tested for the presence of botulinum toxin and/or organisms.

Reflecting on reflections: enhancement of medical education curriculum with structured field notes and guided feedback.

The promotion of reflective capacity within the teaching of clinical skills and professionalism is posited as fostering the development of competent health practitioners. An innovative approach combines structured reflective writing by medical students and individualized faculty feedback to those students to augment instruction on reflective practice. A course for preclinical students at the Warren Alpert Medical School of Brown University, entitled "Doctoring," combined reflective writing assignments (field notes) with instruction in clinical skills and professionalism and early clinical exposure in a small-group format.

A longitudinal comparison of pharmacy and medical students' attitudes toward the medically underserved.

Objective: To longitudinally assess pharmacy and medical students' attitudes toward the medically underserved.

Methods: The Medical Students' Attitudes Toward the Underserved (MSATU) survey was administered to the entering classes at the schools of pharmacy and medicine at 2 universities in the South. This self-report measure was then completed by these students in each year of the professional curriculum.

Working effectively with interpreters: a model curriculum for physician assistant students.

Background: Effective patient-provider communication is crucial to achieving good health care outcomes. To accomplish this with patients of limited English proficiency, learning to work effectively with interpreters is essential.

Aims: The primary goal of this study was to determine if physician assistant students could effectively use interpreters to communicate with Spanish speaking patients after implementation of a cultural competency and Medical Spanish curriculum.

Migrant farmworker stress: mental health implications.

Context: The number of Latinos in rural regions of the United States is increasing. Little is known about factors that undermine the mental health of this segment of the rural population.

Purpose: The goal of this study is to determine which stressors inherent in farmwork and the farmworker lifestyle contribute to poor mental health.

Child healthcare in two farmworker populations.

Children in farmworker families are medically underserved. Little research has documented the healthcare of these children. This analysis uses data collected from two populations of Latino farmworker families, one located in western North Carolina and western Virginia, and the other located in eastern North Carolina, to describe and compare child healthcare utilization and mothers' satisfaction with their children's healthcare.

Isolation of avian paramyxovirus 1 from a patient with a lethal case of pneumonia.

An unknown virus was isolated from a lung biopsy sample and multiple other samples from a patient who developed a lethal case of pneumonia following a peripheral blood stem cell transplant. A random PCR-based molecular screening method was used to identify the infectious agent as avian paramyxovirus 1 (APMV-1; a group encompassing Newcastle disease virus), which is a highly contagious poultry pathogen that has only rarely been found in human infections. Immunohistochemical analysis confirmed the presence of APMV-1 antigen in sloughed alveolar cells in lung tissue from autopsy.

Organophosphorus pesticide urinary metabolite levels of children in farmworker households in eastern North Carolina.

Background: Organophosphorus (OP) pesticide urinary metabolite levels in a sample of farmworker children in North Carolina are documented and compared to national reference data. The relative importance of para-occupational, residential, and environment risk factors are delineated.

Methods: Urine samples were collected from 60 farmworker children 1-6 years of age, and interviews were completed by their mothers.

Housing characteristics of farmworker families in North Carolina.

Adequate housing is a basic human right and an important determinant of environmental health. Little research has documented the housing quality of immigrant Latino farmworker families. This analysis uses data from four surveys of North Carolina farmworker communities conducted in 2001 and 2003 to document aspects of housing quality that could affect farmworker family health.