Research on residents-as-teachers curricula is limited by both the number of studies and their methodology. Despite this, the results demonstrated that residents-as-teachers curricula can significantly improve residents' teaching skills. In addition, the studies' methodologies have improved over time. Using these data, the authors recommend an evidence-based intervention and evaluation, which would include a three-hours-or-longer intervention (and, if possible, periodic reinforcement) based on the One-Minute Preceptor. The evaluation should be a randomized controlled trial using an objective structured teaching examination.
Introduction Insomnia is the most commonly reported sleep disorder and remains undertreated in many patients. New changes to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, have changed the way insomnia is diagnosed. In patients who suffer from insomnia, a number of available treatment options exist including both behavioral therapy and medications. Literature Review: First line therapy for insomnia should always include behavioral modifications such as sleep hygiene and insomnia-oriented cognitive behavioral therapy. In patients deemed to need pharmacotherapy, first line medications include nonbenzodiazepine hypnotics (i.e., z-drugs) and antidepressants depending on the patients’ needs and comorbidities. The risk of next day impairment, parasomnias, and central nervous system depression are some of the most feared side effects with z-drugs. Second line drug therapy includes melatonin and suvorexant. Several concerns exist for suvorexant similar to other insomnia medications, but melatonin remains one of the safest medication alternatives. Other medication options such as benzodiazepines, antihistamines, and antipsychotics should rarely be used because of weak effectiveness data or serious safety concerns. Discussion The most appropriate treatment plan needs to be tailored to meet the needs of individual patients. Many patient factors (e.g., age, other comorbidities, specific problems with sleep) need to be considered before prescribing drug therapy for patients suffering from insomnia. Medications with the best evidence and fewest safety concerns should be prioritized when clinicians work with patients to determine the most appropriate treatment plan. Conclusions Nondrug treatment should be the emphasis for managing insomnia, but several options exist for patients needing multimodal therapy to improve their symptoms and maximize their quality of life. Z-drugs and antidepressants are first line medications options, but other options may be considered when tailored to individual patients. Medications should only be used intermittently and short term until nondrug treatments help to change a patient’s sleep routine.
BACKGROUND Clinical diagnosis and empiric therapy have been strategies for treatment of suspected infl uenza in high-risk patients, but rapid tests for infl uenza have been introduced to help confi rm cases. The aim of this study was to determine when rapid testing, empiric treatment, or no treatment is most cost-beneficial for high-risk adults with infl uenzalike respiratory tract illnesses. METHODSWe performed a cost-benefi t analysis evaluating the comparative advantage of the strategies of empiric therapy, no treatment, or test and treat patients whose tests are positive. The analysis focused on a hypothetical population of patients who are at a high-risk for complications of infl uenza. Our main outcome was the cost of care for an episode of infl uenza taken from the human capital perspective. RESULTSFor older anti-infl uenza drugs (amantadine and rimantadine), rapid testing is not as cost-benefi cial as empiric treatment, even when the prevalence of infl uenza is low. For the neuraminidase inhibitors, there is a narrow window of disease prevalence between 30% and 40% where testing is most cost-benefi cial. When the disease likelihood is above this window, empiric treatment is preferred. Below this window, no treatment is more cost-benefi cial. Even under the most favorable conditions, testing is preferred only for a small range of prevalence rates of infl uenza.CONCLUSION When clinicians are planning to use the nonneuraminidase inhibitors to treat infl uenza, rapid testing is not the most cost-benefi cial approach. Even when the more expensive neuraminidase inhibitors will be used, testing has a limited role in managing infl uenza in high-risk patients.
Background: Pregnant teens in the United States are at high risk for not obtaining prenatal care and for having low-birth weight deliveries. This observation suggests that significant cost savings might be realized if teens were able to obtain prenatal care in a timely fashion.Methods: To determine the optimal time for teens to start prenatal care, we conducted a cost-benefit analysis from the perspective of Medicaid, the predominant payer for pregnancy-related services for teens. Cost projections were based on current recommended prenatal care testing, the cost of vaginal and cesarean deliveries, and the estimated costs for care of the child in the first year of life. We then compared average cost per person and performed sensitivity analyses based on when prenatal care would have started.Results: Compared with no prenatal care, any prenatal care saves between $2,369 and $3,242 per person, depending on when care is initiated. All savings are related to reductions in the cost of caring for low-birth weight babies. We found no cost advantage to starting prenatal care earlier compared with later months. Conclusion
Opioid dependence is becoming a more common problem in the United States that gives rise to many negative health and social consequences for both individuals and society as a whole. Opioid dependence presents a challenging issue for physicians to identify and treat. Understanding and managing withdrawal symptoms is often a necessary first step on the road to recovery for these patients. Long-term therapy options include detoxification, nonpharmacologic treatment plans, and maintenance replacement treatment with either methadone or buprenorphine. Physicians meeting necessary requirements have the option of implementing office-based opioid-assisted maintenance therapy.
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