Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclic vomiting and compulsive bathing behaviors in chronic cannabis users. Patients are typically diagnosed with CHS only after multiple and extensive medical evaluations, consequently without a clear etiology of their symptoms or treatment plan leading to symptomatic improvement. Increased healthcare provider awareness of CHS as a cause of nausea, vomiting, and abdominal pain coupled with an attentiveness to focused history taking-especially noting symptomatic improvement with prolonged exposure to hot showers or baths-can lead to effective treatment through cannabis cessation. We propose a diagnosis and treatment algorithm for physicians to follow when evaluating patients presenting with nausea, vomiting, and abdominal pain who are suspected to suffer from CHS.
Background Future physicians may not be prepared for the challenges of caring for the growing population of poor patients in this country. Given the potential for a socioeconomic “gulf” between physicians and patients and the lack of curricula that address the specific needs of poor patients, resident knowledge about caring for this underserved population is low. Intervention We created a 2-day Resident Academy orientation, before the start of residency training, to improve community knowledge and address resident attitudes toward poor patients through team-based experiential activities. We collected demographic and satisfaction data through anonymous presurvey and postsurvey t tests, and descriptive analysis of the quantitative data were conducted. Qualitative comments from open-ended questions were reviewed, coded, and divided into themes. We also offer information on the cost and replicability of the Academy. Results Residents rated most components of the Academy as “very good” or “excellent.” Satisfaction scores were higher among residents in primary care training programs than among residents in nonprimary care programs for most Academy elements. Qualitative data demonstrated an overall positive effect on resident knowledge and attitudes about community resource availability for underserved patients, and the challenges of poor patients to access high-quality health care. Conclusions The Resident Academy orientation improved knowledge and attitudes of new residents before the start of residency, and residents were satisfied with the experience. The commitment of institutional leaders is essential for success.
Intentional inhalation of methanol fumes may produce toxicity. Clinicians need to question patients, especially older Native American men, regarding the possible inhalation of carburetor cleaning fluid fumes in those who present with an unexplained metabolic anion gap acidosis.
The debate over direct-to-consumer (DTC) screening companies intensi ed recently as Public Citizen, a consumer advocacy organization, sent letters to 20 hospitals on June 19, 2014, urging their leadership to sever business relationships with HealthFair, a prominent DTC screening company. Public Citizen states that HealthFair's "heavily promoted, community-wide cardiovascular health screening programs are unethical and are much more likely to do harm than good," and they cite peer-reviewed evidence in support of their claims. 1 If such claims are true, should any hospital sponsor or co-brand with DTC screening companies that allegedly sell "potentially harmful and unethical services?" (For example, sponsorship arrangements include allowing the use of a hospital's name in DTC company print or online advertising, providing or sharing a physical location where screening is performed, or both; co-branding includes promotion of a DTC screening company on a hospital's website.)Hospitals exist to provide medical services to the general community. To deliver on their missions, hospitals must have a su cient number of patients use services to fund their operations. In an increasingly competitive health care environment, one strategy to bring in new "customers" is to sponsor outreach programs that
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