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  1. Article ; Online: Gynecomastia in a Patient Taking Meloxicam—A Case Report

    Steven L. Rosas / Mark E. Deyo-Svendsen / Rachel Z. Oldfather / Michael R. Phillips / T. Andrew Israel / Emily R. Weisenbeck

    Journal of Primary Care & Community Health, Vol

    2020  Volume 11

    Abstract: Gynecomastia is benign enlargement of glandular tissue in the male breast. It occurs due to an imbalance of estrogen and testosterone. It may be unilateral or bilateral. Physiologic gynecomastia commonly occurs in infants and during puberty and is self- ... ...

    Abstract Gynecomastia is benign enlargement of glandular tissue in the male breast. It occurs due to an imbalance of estrogen and testosterone. It may be unilateral or bilateral. Physiologic gynecomastia commonly occurs in infants and during puberty and is self-limited. Gynecomastia may affect up to 50% of adult men over age 50 years old and can be related to underlying medical illness or caused by certain medications. Known causative agents include anti-androgenic and estrogenic drugs. Probable agents include alcohol and anti-ulcer, psychoactive, and antiretroviral medications. Non-steroidal anti-inflammatory drugs (NSAIDs) are not commonly associated with the development of gynecomastia. This case presents an instance in which the NSAID, meloxicam, was the only identified variable in a patient who developed unilateral gynecomastia. His breast tenderness and abnormal exam resolved spontaneously within 4 weeks of cessation of meloxicam therapy.
    Keywords Computer applications to medicine. Medical informatics ; R858-859.7 ; Public aspects of medicine ; RA1-1270
    Subject code 616
    Language English
    Publishing date 2020-09-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: A Model for Improving Adherence to Prescribing Guidelines for Chronic Opioid Therapy in Rural Primary Care

    Terrence J. Witt, MD / Mark E. Deyo-Svendsen, MD / Elizabeth R. Mason, MSN, RN / James R. Deming, MD / Kyja K. Stygar, MD / Steven L. Rosas, MD / Michael R. Phillips, MD / Abd Moain Abu Dabrh, MBBCh, MS

    Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 2, Iss 4, Pp 317-

    2018  Volume 323

    Abstract: Objective: To describe the steps taken and results obtained by a rural primary care practice to effectively implement opioid prescribing guidelines. Patients and Methods: Between December 1, 2014, and May 30, 2017, a quality improvement project was ... ...

    Abstract Objective: To describe the steps taken and results obtained by a rural primary care practice to effectively implement opioid prescribing guidelines. Patients and Methods: Between December 1, 2014, and May 30, 2017, a quality improvement project was undertaken. Elements included prescribing registries, a nurse coordinator, and an Opioid Use Review Panel. Clinic workflow was redesigned to more consistently incorporate these and other guideline recommendations into practice. The effect on opioid prescribing was measured as well as patient outcomes. Results: There were 462 patients meeting inclusion criteria before implementation. At the conclusion, 16 patients (3%) had died, 9 patients (2%) were no longer seeing clinicians participating in the project, and 2 patients (0.4%) had transitioned to hospice or long-term care facilities. Of the remaining 435 patients, 96 (22.1%; 95% CI, 18.4-26.2) had decreased prescribing below the threshold for inclusion or were no longer receiving opioid prescriptions. Originally, 64 patients (13.9%; 95% CI, 11.0-17.3) were using average daily doses equal to or greater than 90 morphine milligram equivalents. After implementation, 54 of 435 patients (12.4%; 95% CI, 9.6-15.8) were still using equal to or greater than 90 morphine milligram equivalents per day after accounting for death or loss to follow-up. Conclusion: A change in clinic process to implement guidelines for prescribing of chronic opioid therapy was completed. It was associated with a decrease in the number of patients using chronic opioid therapy, primarily at lower doses. This was accomplished in a rural practice with very limited resources in pain medicine, psychiatry, and addiction medicine.
    Keywords Medicine (General) ; R5-920
    Subject code 610 ; 616
    Language English
    Publishing date 2018-12-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Clinician Care Team Composition and Health Care Utilization

    Matthew E. Bernard, MD / Susan B. Laabs, MD / Darshan Nagaraju, MS / Summer V. Allen, MD / Michael P. Halasy, DHSc, MS, PA-C / David R. Rushlow, MD / Gregory M. Garrison, MD / Julie A. Maxson, CCRP / Marc R. Matthews, MD / Gerald J. Sobolik, MBA / Michelle A. Lampman, PhD / Randy M. Foss, MD / Steven L. Rosas, MD / Tom D. Thacher, MD

    Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 5, Iss 2, Pp 338-

    2021  Volume 346

    Abstract: Objective: To test the hypothesis that a greater proportion of physician time on primary care teams are associated with decreased emergency department (ED) visits, hospital admissions, and readmissions, and to determine clinician and care team ... ...

    Abstract Objective: To test the hypothesis that a greater proportion of physician time on primary care teams are associated with decreased emergency department (ED) visits, hospital admissions, and readmissions, and to determine clinician and care team characteristics associated with greater utilization. Patients and Methods: We retrospectively analyzed administrative data collected from January 1 to December 31, 2017, of 420 family medicine clinicians (253 physicians, 167 nurse practitioners/physician assistants [NP/PAs]) with patient panels in an integrated health system in 59 Midwestern communities serving rural and urban areas in Minnesota, Wisconsin, and Iowa. These clinicians cared for 419,581 patients through 110 care teams, with varying numbers of physicians and NP/PAs. Primary outcome measures were rates of ED visits, hospitalizations, and readmissions. Results: The proportion of physician full-time equivalents on the team was unrelated to rates of ED visits (rate ratio [RR] = 0.826; 95% confidence interval [CI], 0.624 to 1.063), hospitalizations (RR = 0.894; 95% CI, 0.746 to 1.072), or readmissions (RR = –0.026; 95% CI, 0.364 to 0.312). In separate multivariable models adjusted for clinician and practice-level characteristics, the rate of ED visits was positively associated with mean panel hierarchical condition category (HCC) score, urban vs rural setting, NP/PA vs physician, and lower years in practice. The rate of inpatient admissions was associated with HCC score, and 30-day hospital readmissions were positively associated with HCC score, lower years in practice, and male clinicians. Conclusion: Care team physician and NP/PA composition was not independently related to utilization. More complex panels had higher rates of ED visits, hospitalization, and readmissions. Statistically significant differences between physician and NP/PA panels were only evident for ED visits.
    Keywords Medicine (General) ; R5-920
    Subject code 360
    Language English
    Publishing date 2021-04-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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    Inter-library loan at ZB MED

    Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

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