Tom Heston

Clinic systems and the quality of care for older adults in residency clinics and in physician practices.

Acad Med. 2009 Dec;84(12):1732-40

Authors: Lynn LA, Hess BJ, Conforti LN, Lipner RS, Holmboe ES

PURPOSE: The U.S. health care system is not prepared to meet the needs of the increasing population of older adults. Few physicians become geriatricians, but most will care for older adults. The authors assessed the quality of care for older adults in residency clinics and physician practices. METHOD: Using the American Board of Internal Medicine’s Care of the Vulnerable Elderly practice improvement module, researchers studied the quality of care provided to older adults in 52 internal and family medicine residency clinic sites and by a motivated group of 144 practicing physicians from 2006 to 2008. They also studied the characteristics of the practice systems in the clinics and offices and the relationship between specific elements of practice systems and the quality of care. RESULTS: Patients seen by residents were younger, had fewer chronic conditions, and were less likely to receive recommended care. Residency clinic systems were less likely to have elements designed to support care for older adults. Even when present, there was little correlation with care provided. Practicing physicians were more likely to provide recommended processes of care, and system elements in their practices were more likely to function well and correlate with delivery of key processes of care, but much room for improvement remains. CONCLUSIONS: Practice system elements designed to support care for older adults perform differently in residency clinics than in practicing physicians’ offices. Significant gaps in the quality of care for older adults exist and are much more pronounced in the residency clinic setting.

19940582

– Clinic systems and the quality of care for older adults in residency clinics and in physician practices.

Prevention of drowning.

Pediatrics. 2010 Jul;126(1):e253-62

Authors: Weiss J,

Drowning is a leading cause of injury-related death in children. In 2006, approximately 1100 US children younger than 20 years died from drowning. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in the prevention of drowning.

20498167

– Prevention of drowning.

Acute radiation syndrome: assessment and management.

South Med J. 2010 Jun;103(6):541-6

Authors: Donnelly EH, Nemhauser JB, Smith JM, Kazzi ZN, Farfán EB, Chang AS, Naeem SF

Primary care physicians may be unprepared to diagnose and treat rare, yet potentially fatal, illnesses such as acute radiation syndrome (ARS). ARS, also known as radiation sickness, is caused by exposure to a high dose of penetrating, ionizing radiation over a short period of time. The time to onset of ARS is dependent on the dose received, but even at the lowest doses capable of causing illness, this will occur within a matter of hours to days. This article describes the clinical manifestations of ARS, provides guidelines for assessing its severity, and makes recommendations for managing ARS victims.

20710137

– Acute radiation syndrome: assessment and management.