Background Residency training occurs in varied settings. Whether there are differences in the training received by graduates of community- or medical school–based programs has been the subject of debate. Objective This study examined the perceived preparation for practice, scope of practice, and American Board of Family Medicine (ABFM) board examination pass rates of family physicians in relation to the type of residency program (community, medical school, or partnership) in which they trained. Methods Predetermined survey responses were abstracted from the 2016 and 2017 National Family Medicine Graduate Survey of ABFM and linked to data about residency programs obtained from the websites of national organizations. Descriptive statistics were used to summarize the data and logistic regression to examine differences between survey results based on type of residency training: community, medical school, or partnership. Results Differences in the perception of preparation as well as current scope of practice were noted for the 3 residency types. The differences in perception were mainly noted in hospital-based skills, such as intubation and ventilator management, and in women's health and family planning services, with different program types increasing preparedness perception in different domains. Conclusions In general, graduates of family medicine community-based, non-affiliated, and partnership programs perceived they were prepared for and were providing more of the services queried in the survey than graduates of medical school–based programs.
Background: Increases in emergency department (ED) use are contributing to inefficient health care spending and becoming a public health concern. Previous studies have identified characteristics of ED high utilizers aimed at designing interventions to improve efficiency. We aim to expand on these findings in a family medicine outpatient population. Methods: We conducted a retrospective analysis on a population of ED high utilizers, defined as those who had been to the ED 6 or more times in 1 year, including medical and demographic characteristics from 2015 to 2017. Results: Compared with our source population, ED high utilizers were most commonly female, African American, or single and insured by Medicare or Medicaid. They did not have a chronic pain or substance use diagnosis, but more than half had a psychiatric condition. The only demographic characteristic that changed over time was home location from 2015 to 2017 (P < .05). Less than 10% of ED high utilizers were the same over 3 years. Conclusions: Most demographic characteristics did not change over time, whereas individuals did change. Interventions aimed at improving efficiency of ED use should be geared toward unchanging characteristics rather than individuals. The only demographic characteristic that did change significantly was home location that correlated in time with the availability of new EDs providing support for a theory of supply-sensitive ED use.
Our study showed frequency-dependent production of ABA in response to BCB2024 BTA administration in a murine model. The clinical significance of such antibody production remains to be determined. Presently however, no standardized scale of conversion exists to relate murine doses of BTA to those used in human treatment regimens.
Objectives
In order to evaluate the therapeutic potential of resolvins to reduce inflammation in CCI-PICS, we recapitulated Glue Grant leukotriene and resolvin lipidomic scores above to quantify lipidomics in severe sepsis/septic shock survivors.
Methods
Ongoing University of Florida (UF) Sepsis Critical Illness Research Center (SCIRC) research studies indicate that Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS) occurs as a result of a self-perpetuating cycle of low-grade inflammation. However, specialized pro-resolving mediators (SPMs) – metabolically active lipid byproducts of omega-3 fatty acids – can promote inflammatory deceleration and resolution.,1 Post hoc analysis of the Glue Grant Data developed a mathematical lipidomic expression to better understand genes responsible for production and degradation of resolvins and leukotrienes.,2
Leukotriene Score = (ALOX5 * ALX5AP * LTA4H * LTB4R)/(HPGD + PTGR1 + CYP4F3)
Resolvin Score = [(ALOX5 * ALOX15) * (FPR2 + GPR32 + CMKLR1)]/(HPGD + PTGR1)
When the targeted genes were scored using a weighted scheme accounting for enzyme and receptor activity, patients with uncomplicated recoveries had higher resolvin scores (P < 0.001) and lower leukotriene scores (P < 0.001).
Utilizing our PICS patient data, we recapitulated the aforementioned lipidomic scores above to quantify expression in severe sepsis/septic shock survivors.
Results
Leukotriene and resolvin scores are depicted in Figure 1 at specific time points 0 (healthy controls), 3 hours, 1 and 14 days. The leukotriene score remains elevated consistent with ongoing inflammatory genotypic expression. Interestingly, the resolvin score also remains elevated in the CCI (Glue Grant complicated cohort) patient population when compared to our Rapid Recovery (RAP or uncomplicated) patients
*Accompanied by two graphs depicting correlating numerical values for the aforementioned Leukotriene and Resolvin scores.
Conclusions
In our patient population of sepsis survivors, the leukotriene score is similarly elevated to the complicated Glue Grant patients of polytrauma. The resolvin score, however, remains elevated in the CCI-PICS population compared to RAP; this is contrary to expected scores if resolution of inflammation is predicted.
Funding Sources
University of Florida.
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