referral and consultation

Importance Shoulder pain is a common and disabling condition most often managed in primary care. This review provides an evidence-based update on the diagnosis and management of shoulder pain to support clinical decision-making and improve patient outcomes.

Observations Shoulder pain arises from benign, self-limiting soft-tissue disorders or rare but serious causes. In primary care, most cases are nontraumatic and involve periarticular soft tissues. The subacromial region is the most frequent source of pain, and the term subacromial pain is preferred over overlapping and inconsistently defined labels such as rotator cuff tendinopathy or tear, impingement syndrome, or subacromial bursitis. Less commonly, pain originates from the glenohumeral joint, as in glenohumeral osteoarthritis or adhesive capsulitis. Assessment should focus on a detailed history and physical examination to assess pain patterns and movement limitation and to exclude serious causes, such as infection, malignant neoplasm, or nonshoulder referred pain. Once these are excluded, first-line treatment is similar for most patients and aligns with recommended care for other regional musculoskeletal concerns: education about the favorable natural history, symptom relief and activity modification if needed, and watchful waiting. Early imaging is not indicated in the absence of significant trauma or suspicious features, such as fever, unexplained weight loss, or history of malignant neoplasm, as structural abnormalities often do not correlate with symptoms, rarely alter management, and may lead to overdiagnosis and overtreatment. Specialist referral should be reserved for suspected serious pathology, such as infection, malignant neoplasm, fracture, or dislocation; significant functional or neurologic deficit; features suggestive of systemic inflammatory disease; or persistent or worsening pain and debility. High-certainty evidence indicates that subacromial pain does not benefit from surgical intervention.

Conclusions and Relevance Shoulder pain is the third most common musculoskeletal presentation in primary care. Although causes vary, the initial management is largely the same once serious conditions have been excluded. Most patients with subacromial pain will fully recover with minimal intervention and can be safely treated with supportive care. Imaging and referral to surgical subspecialists should be reserved for rare and carefully selected cases to avoid unnecessary intervention.

Author/s:

Romi Haas, Thomas Ibounig, MD, Buchbinder, Rachelle

Improving behavioral health outcomes in primary care

Alex Haga — Mon, 13 May 2024 21:14:31 +0000

Date Added:

May 13, 2024

Journal/Publication:

Oklahoma Primary Healthcare Improvement Cooperative

Type:

Best Local Practices

Format:

Article

Keywords

MeSH

referral and consultation

An overview of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) initiative being implemented in primary care practices in Oklahoma. James W. Mold, MD, MPH

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Screening, Brief Intervention, and Referral to Treatment in Oklahoma (SBIRT-OK)
is an evidence-based, integrated approach to identify and intervene with patients whose
patterns of tobacco, alcohol, and/or drug use, or depression, put their health at risk.

Age and Probability of Spontaneous Umbilical Hernia Closure

Erin Blanchette — Tue, 19 Mar 2024 17:51:29 +0000

Date Added:

March 19, 2024

Journal/Publication:

JAMA Pediatrics

Publisher:

American Medical Association

Publication Date:

March 11, 2024

URL:

Age and Probability of Spontaneous Umbilical Hernia Closure

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamapediatrics.2024.0087

Keywords

PMID (1):

38466296

MeSH

referral and consultation

A concise report on the probability of spontaneous umbilical hernia closure across ages 0 to 5 years. The figure is particularly helpful. James W. Mold, MD, MPH

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This cohort study of children younger than 6 years uses electronic health records to investigate whether a child’s age is associated with the probability of spontaneous umbilical hernia closure and to refine guidelines for surgical repair.

Author/s:

Katherine He, Dionne A Graham, Louis Vernacchio, Jonathan Hatoun, Laura Patane, Shannon L Cramm, Shawn J Rangel

Neutropenia

Aubrey Delammermore — Sat, 07 Jan 2023 06:00:00 +0000

Date Added:

January 7, 2023

Journal/Publication:

Canadian Medical Association Journal

Publisher:

CMA Impact Inc

Publication Date:

December 19, 2022

Issue:

Volume:

194

Pages:

E1689

URL:

Neutropenia

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.220499

Keywords

PMID (1):

36535676

MeSH

referral and consultation

A concise summary of the causes and evaluation of neutropenia. James W. Mold, MD, MPH

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»Neutropenia is seen in 5%–10% of healthy people
Based on absolute neutrophil count, neutropenia is commonly defined as
mild (1.0–1.5 × 109
/L), moderate (0.5–0.9 × 109
/L) or severe (< 0.5 × 109
/L).1
However, the reference interval is specific to the population. Mild asymptomatic neutropenia per the above definition is common in people of subSaharan African, Arab or West Indian ancestry,2
and is strongly associated
with the Duffy-null phenotype of red blood cells that protects against
Plasmodium vivax malaria.
2 Common causes include medications, infection, nutritional
deficiency, malignant disease and autoimmune disease
Causes include underproduction (e.g., myelodysplastic syndrome),
immune-mediated destruction or redistribution of neutrophils to the
endothelium and reticuloendothelial system. Antithyroid, anti-infective
and psychotropic drugs, as well as chemotherapy, are causes of druginduced neutropenia.3,4 Transient neutropenia may occur after acute
viral infection and typically resolves within 2 weeks. Joint swelling, rash,
bony pain, splenomegaly or lymphadenopathy may suggest malignant or
autoimmune disease.
3Investigation should begin with a repeat complete blood count
and peripheral blood film
Neutropenia is often identified incidentally. Persistent and unexplained
neutropenia requires further work-up for a range of causes, including
chronic viral infection (e.g., hepatitis, HIV) and nutritional deficiency (e.g.,
vitamin B12) (Appendix 1, available at www.cmaj.ca/lookup/doi/10.1503/
cmaj.220499/tab-related-content).
4 Treatment of mild neutropenia should be directed at the
underlying cause
Patients with mild neutropenia are not at substantially increased risk of
infection.5
The neutrophil count should be checked every 3–6 months for
at least 1 year to rule out progression to more severe neutropenia.
5 Patients with moderate-to-severe neutropenia for more than
6 months should be referred to a specialist
Patients with recurrent or severe bacterial infections (e.g., requiring hospital admission or intravenous antibiotics), abnormalities on peripheral blood
films (e.g., circulating blasts, hairy cells, large granular lymphocytes, dysplastic granulocytes) or pancytopenia also warrant referral to a specialist
(e.g., hematologist, internist, pediatrician).1
Febrile neutropenia (absolute
neutrophil count < 0.5 × 109
/L and an oral temperature > 38.0°C sustained
over 1 h) requires immediate treatment with broad-spectrum antibiotics.

Author/s:

Mithoowani, Siraj, Cameron, L., Crowther, M. A.

Prevalence of Allergic Reactions After Pfizer-BioNTech COVID-19 Vaccination Among Adults With High Allergy Risk

Bethie Seay — Fri, 03 Sep 2021 05:00:00 +0000

Date Added:

September 3, 2021

Type:

Clinical Research Results

DOI (1):

10.1001/jamanetworkopen.2021.22255

MeSH

referral and consultation

Surveys and Questionnaires

Algorithms

SARS-CoV-2

Highly allergic individuals can safely receive the COVID vaccine if certain precautions are taken. Anaphylaxis is very unlikely (0.7%).

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Importance
Allergic reactions among some individuals who received the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine discourage patients with allergic conditions from receiving this vaccine and physicians from recommending the vaccine.

Objective
To describe the assessment and immunization of highly allergic individuals with the BNT162b2 vaccine.

Design, Setting, and Participants
In a prospective cohort study from December 27, 2020, to February 22, 2021, 8102 patients with allergies who applied to the COVID 19 vaccine referral center at the Sheba Medical Center underwent risk assessment using an algorithm that included a detailed questionnaire. High-risk patients (n = 429) were considered “highly allergic” and were immunized under medical supervision.

Exposures
Pfizer-BioNTech (BNT162b2) COVID-19 vaccine.

Main Outcomes and Measures
Allergic and anaphylactic reactions after the first and second doses of BNT162b2 vaccine among highly allergic patients.

Results
Of the 429 individuals who applied to the COVID-19 referral center and were defined as highly allergic, 304 (70.9%) were women and the mean (SD) age was 52 (16) years. This highly allergic group was referred to receive immunization under medical supervision. After the first dose of the BNT162b2 vaccine, 420 patients (97.9%) had no immediate allergic event, 6 (1.4%) developed minor allergic responses, and 3 (0.7%) had anaphylactic reactions. During the study period, 218 highly allergic patients (50.8%) received the second BNT162b2 vaccine dose, of which 214 (98.2%) had no allergic reactions and 4 patients (1.8%) had minor allergic reactions. Other immediate and late reactions were comparable with those seen in the general population, except for delayed itch and skin eruption, which were more common among allergic patients.

Conclusions and Relevance
The rate of allergic reactions to BNT162b2 vaccine, is higher among patients with allergies, particularly among a subgroup with a history of high-risk allergies. This study suggests that most patients with a history of allergic diseases and, particularly, highly allergic patients can be safely immunized by using an algorithm that can be implemented in different medical facilities and includes a referral center, a risk assessment questionnaire, and a setting for immunization under medical supervision of highly allergic patients. Further studies are required to define more specific risk factors for allergic reactions to the BNT162b2 vaccine.

Author/s:

Shavit, R., Maoz-Segal, R., Iancovici-Kidon, M.

Integrating Physical Therapists Into Primary Care Within A Large Health Care System

Saige Blanchard — Fri, 06 Aug 2021 05:00:00 +0000

Date Added:

August 6, 2021

Journal/Publication:

Journal of the American Board of Family Medicine

Publisher:

JABMF

Publication Date:

July 26, 2021

Issue:

Volume:

Pages:

866-870

URL:

Integrating Physical Therapists Into Primary Care Within A Large Health Care System

Type:

Best Local Practices, Practice Management Research Results

Format:

Article

DOI (1):

https://doi.org/10.3122/jabfm.2021.04.200432

Keywords

PMID (1):

34312283

MeSH

COVID-19

Patient Satisfaction

Fee-for-Service Plans

Patient Handoff

Physical Therapists

referral and consultation

A description of one health care system’s experience integrating physical therapists into primary care teams. James W. Mold, MD, MPH

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Background: Bellin Health in Wisconsin has pioneered the colocation and integration of physical therapists into primary care pods.

Methods: This is an observational study based on one in-person visit and several interviews.

Results: For patients with musculoskeletal complaints, providers make warm handoffs to the physical therapist, who is a few steps away. The physical therapist performs most of the visit, providing diagnosis, treatment, and patient education. Research studies show that-compared with physician management-appropriate patients managed by physical therapists have better outcomes, lower costs, and higher patient satisfaction. In a fee-for-service environment, the business case for this innovation requires an increased number of follow-up referrals to the physical therapy department. In the Coronavirus disease 2019 (COVID-19) era, physical therapists can provide video visits with equal quality compared with in-person visits.

Conclusion: The Bellin Health program is a blueprint for other primary care practices to integrate physical therapists into primary care teams.

Author/s:

Bodenheimer, T., Kucksdorf, J., Torn, A., Jerzak, J.

Management of Blood Pressure in Patients With Chronic Kidney Disease Not Receiving Dialysis: Synopsis of the 2021 KDIGO Clinical Practice Guideline

Saige Blanchard — Wed, 23 Jun 2021 05:00:00 +0000

Date Added:

June 23, 2021

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

June 22, 2021

URL:

Management of Blood Pressure in Patients With Chronic Kidney Disease Not Receiving Dialysis: Synopsis of the 2021 KDIGO Clinical Practice Guideline

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M21-0834

Keywords

PMID (1):

34152826

MeSH

blood pressure

renal dialysis

Renal Replacement Therapy

referral and consultation

risk assessment

renal insufficiency, chronic

Eleven guideline recommendations for management of elevated BP in patients with CKD from the Kidney Disease: Improving Global Outcomes (KDIGO). James W. Mold, MD, MPH

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Description: The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 clinical practice guideline for the management of blood pressure (BP) in patients with chronic kidney disease (CKD) not receiving dialysis is an update of the KDIGO 2012 guideline on the same topic and reflects new evidence on the risks and benefits of BP-lowering therapy among patients with CKD. It is intended to support shared decision making by health care professionals working with patients with CKD worldwide. This article is a synopsis of the full guideline.

Methods: The KDIGO leadership commissioned 2 co-chairs to convene an international Work Group of researchers and clinicians. After a Controversies Conference in September 2017, the Work Group defined the scope of the evidence review, which was undertaken by an evidence review team between October 2017 and April 2020. Evidence reviews were done according to the Cochrane Handbook. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to guide the development of the recommendations and rate the strength and quality of the evidence. Practice points were included to provide guidance when evidence was insufficient to make a graded recommendation. The guideline was revised after public consultation between January and March 2020.

Recommendations: The updated guideline comprises 11 recommendations and 20 practice points. This synopsis summarizes key recommendations pertinent to the diagnosis and management of high BP in adults with CKD, excluding those receiving kidney replacement therapy. In particular, the synopsis focuses on recommendations for standardized BP measurement and a target systolic BP of less than 120 mm Hg, because these recommendations differ from some other guidelines.

Author/s:

Tomson, C. R. V., Cheung, A. K., Mann, J. F. E., Chang, T. I., Cushman, W. C., Furth, S. L., Hou, F. F., Knoll, G. A., Muntner, P., Pecoits-Filho, R., Tobe, S. W., Lytvyn, L, Craig, J. C., Tunnicliffe, D. J., Howell, M., Tonelli, M., Cheung, M., Earley, A., Ix, J. H., Sarnak, M. J.

Facilitating rapid access to addiction treatment: a randomized controlled trial

Bethie Seay — Thu, 03 Jun 2021 05:00:00 +0000

Date Added:

June 3, 2021

Type:

Clinical Research Results

DOI (1):

10.1186/s13722-021-00240-y

PMID (1):

34034821

MeSH

referral and consultation

Emergency Service, hospital

patient acceptance of healthcare

National Institutes of Health (U.S.)

Not surprisingly, rapid access to addiction treatment works better than delayed access.

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Background: Obtaining timely access to addiction medicine treatment for patients with substance use disorders is challenging and patients often have to navigate complex referral pathways. This randomized controlled trial examines the effect of providing an expedited pathway to addiction medicine treatment on initial treatment engagement and health care utilization.

Methods: Individuals with possible alcohol or opioid use disorder were recruited from three residential withdrawal management services (WMS). Subjects randomized to the Delayed Intervention (DI) group were given contact information for a nearby addiction medicine clinic; those randomized to the Rapid Intervention (RI) group were given an appointment at the clinic within 2 days and were accompanied to their first appointment.

Results: Of the 174 individuals who were screened, 106 were randomized to either the DI or RI group. The two groups were similar in demographics, housing status, and substance use in the last 30 days. In the 6-month period following randomization, 85% of the RI group attended at least one clinic appointment, compared to only 29% in the DI group (p < 0.0001). The RI group had a mean of 6.39 ED visits per subject in the 12 months after randomization, while the DI group had a mean of 13.02 ED visits per subject in the same 12-month period (p = 0.0469). Other health utilization measures did not differ between the two groups.

Conclusion: Providing immediate facilitated access to an addiction medicine service resulted in greater initial engagement and reduced emergency department visits at 6 months. Trial registration This trial is registered at the National Institutes of Health (ClinicalTrials.gov) under identifier #NCT01934751.

Author/s:

Srivastava, Anita, Clarke, Sarah, Hardy, Kate, Kahan, Meldon

Hematuria as a Marker of Occult Urinary Tract Cancer: Advice for High-Value Care From the American College of Physicians

Bethie Seay — Tue, 25 May 2021 05:00:00 +0000

Date Added:

May 25, 2021

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.7326/M15-1496

PMID (1):

26810935

MeSH

Adult

asymptomatic diseases

physicians, primary care

Platelet Aggregation Inhibitors

practice guidelines as topic

practice patterns, physicians'

referral and consultation

risk factors

urinalysis

urologic neoplasms

A quick summary of ACP guidance regarding evaluation of hematuria in adults.

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Background: The presence of blood in the urine, or hematuria, is a common finding in clinical practice and can sometimes be a sign of occult cancer. This article describes the clinical epidemiology of hematuria and the current state of practice and science in this context and provides suggestions for clinicians evaluating patients with hematuria.

Methods: A narrative review of available clinical guidelines and other relevant studies on the evaluation of hematuria was conducted, with particular emphasis on considerations for urologic referral.

High-value care advice 1: Clinicians should include gross hematuria in their routine review of systems and specifically ask all patients with microscopic hematuria about any history of gross hematuria.

High-value care advice 2: Clinicians should not use screening urinalysis for cancer detection in asymptomatic adults.

High-value care advice 3: Clinicians should confirm heme-positive results of dipstick testing with microscopic urinalysis that demonstrates 3 or more erythrocytes per high-powered field before initiating further evaluation in all asymptomatic adults.

High-value care advice 4: Clinicians should refer for further urologic evaluation in all adults with gross hematuria, even if self-limited.

High-value care advice 5: Clinicians should consider urology referral for cystoscopy and imaging in adults with microscopically confirmed hematuria in the absence of some demonstrable benign cause.

High-value care advice 6: Clinicians should pursue evaluation of hematuria even if the patient is receiving antiplatelet or anticoagulant therapy.

High-value care advice 7: Clinicians should not obtain urinary cytology or other urine-based molecular markers for bladder cancer detection in the initial evaluation of hematuria.

Author/s:

Nielsen, Matthew, Qaseem, Amir, High Value Care Task Force of the American College of Physicians

Bronchoscopic Lung Volume Reduction: A New Hope for Patients With Severe Emphysema and Air Trapping

Brian Desmarais — Mon, 31 Aug 2020 21:38:45 +0000

Date Added:

August 31, 2020

Journal/Publication:

Mayo Clinic proceedings

Publication Date:

August 20, 2020

URL:

Bronchoscopic Lung Volume Reduction: A New Hope for Patients With Severe Emphysema and Air Trapping

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi: 10.1016/j.mayocp.2020.03.027

MeSH

Residual Volume

Pneumonectomy

Cost-Benefit Analysis

cause of death

Pulmonary Emphysema

pulmonary disease, chronic obstructive

Lung Volume Measurements

Lung

Dyspnea

Emphysema

referral and consultation

This relatively new procedure is probably worth knowing about. I’m not sure where, other than Mayo, it is being done. James W. Mold, MD, MPH

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Chronic obstructive pulmonary disease (COPD) is common and has significant morbidity and mortality as the fourth leading cause of death in the United States. In many patients, particularly those with emphysema, COPD is characterized by markedly increased residual volume contributing to exertional dyspnea. Current therapies have limited efficacy. Surgical resection of diseased areas of the lung to reduce residual volume was effective in identified subgroups but also had significant mortality in and suboptimal cost effectiveness. Lung-volume reduction, using bronchoscopic techniques, has shown substantial benefits in a broader patient population with less morbidity and mortality. This review is meant to spread the awareness about bronchoscopic lung-volume reduction and to promote its consideration and early referral for patients with advanced COPD and emphysema frequently encountered by both primary care physicians and specialists. A search was conducted on PubMed (MEDLINE), EMbase, and Cochrane library for original studies, using the following keywords: "lung-volume reduction." "endobronchial valves," "intrabronchial valves," "bronchoscopic lung-volume reduction," and "endoscopic lung-volume reduction." We included reports from systematic reviews, narrative reviews, clinical trials, and observational studies. Two reviewers evaluated potential references. A total of 27 references were included in our review. Included studies report experience in the diagnosis and bronchoscopic treatment for emphysema; case reports and non-English or non-Spanish studies were excluded.

Author/s:

Abia-Trujillo, David, Johnson, Margaret M, Patel, Neal M, Hazelett, Britney, Eric S Edell, Kern, Ryan

The 2020 Medicare Documentation, Coding, and Payment Update

Brian Desmarais — Fri, 03 Jan 2020 19:58:25 +0000

Date Added:

January 3, 2020

Journal/Publication:

Mayo

Publisher:

American Academy of Family Physicians

Publication Date:

December 12, 2019

URL:

The 2020 Medicare Documentation, Coding, and Payment Update

Type:

Practice Management Reviews and Guidelines

Format:

Article

Keywords

coding

MeSH

Centers for Medicare and Medicaid Services, U.S.

referral and consultation

abdominal pain

Records

Major changes in coding will occur in 2021, but this 2020 update is also important. James W. Mold, MD, MPH

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As usual, the new year brings changes in how doctors bill and get paid for the services they provide to Medicare patients. The reforms that will most affect family physicians’ pay aren’t coming until 2021, when several changes in evaluation and management (E/M) coding and payment are projected to result in a 12% increase for family medicine.1 But there are still a host of things family physicians should know for 2020, including new codes to help you get paid for interacting with patients via the internet and new codes that should help make chronic care management (CCM) more financially rewarding. The Centers for Medicare & Medicaid Services (CMS) is also continuing its quest to streamline documentation requirements and develop new payment models intended to reward quality instead of volume. This article summarizes the 2020 changes most relevant to family medicine. As always, private payers’ policies may differ, so consult with your billing staff to understand any important differences.

Author/s:

Moore, K., Mullins, A., Solis, E.

Vaccines for International Travel

John Bayhi — Sat, 02 Nov 2019 16:19:59 +0000

Date Added:

November 2, 2019

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Mayo Foundation for Medical Education and Research

Publication Date:

November 1, 2019

Issue:

Volume:

Pages:

2314-2339

URL:

Vaccines for International Travel

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2019.02.025

Keywords

MeSH

referral and consultation

Liver Diseases

Travel-Related Illness

This is a summary of current vaccination recommendations for travelers to foreign countries. James W. Mold, MD, MPH

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The pretravel management of the international traveler should be based on risk management principles. Prevention strategies and medical interventions should be based on the itinerary, preexisting health factors, and behaviors that are unique to the traveler. A structured approach to the patient interaction provides a general framework for an efficient consultation. Vaccine-preventable diseases play an important role in travel-related illnesses, and their impact is not restricted to exotic diseases in developing countries. Therefore, an immunization encounter before travel is an ideal time to update all age-appropriate immunizations as well as providing protection against diseases that pose additional risk to travelers that may be delineated by their destinations or activities. This review focuses on indications for each travel-related vaccine together with a structured synthesis and graphics that show the geographic distribution of major travel-related diseases and highlight particularly high-risk destinations and behaviors. Dosing, route of administration, need for boosters, and possible accelerated regimens for vaccines administered prior to travel are presented. Different underlying illnesses and medications produce different levels of immunocompromise, and there is much unknown in this discipline. Recommendations regarding vaccination of immunocompromised travelers have less of an evidence base than for other categories of travelers. The review presents a structured synthesis of issues pertinent to considerations for 5 special populations of traveler: child traveler, pregnant traveler, severely immunocompromised traveler, HIV-infected traveler, and traveler with other chronic underlying disease including asplenia, diabetes, and chronic liver disease.

Author/s:

Freedman, DO, Chen, LH

A Practical Guide To Conducting A Child Sexual Abuse Examination

Brian Desmarais — Mon, 23 Sep 2019 13:42:35 +0000

Date Added:

September 23, 2019

Journal/Publication:

Pediatrics and Child Health

Publication Date:

September 1, 2019

Issue:

Volume:

Pages:

448–454

URL:

A Practical Guide To Conducting A Child Sexual Abuse Examination

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1016/j.paed.2019.07.006

Keywords

child abuse

Sexual abuse

Examination

MeSH

referral and consultation

A review of how physicians should approach the evaluation of a child who may have been sexually abused. Unfortunately only the abstract is available for free, but the information it contains is useful, and those who need or want to know more can purchase the article. James W. Mold, MD, MPH

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If you work with children, then you are seeing children who have been sexually abused. Many presentations in a health setting go unrecognised.

It is a field of paediatric practice that has changed rapidly over the last fifteen years. The evidence base is now set out by the RCPCH, giving a much clearer steer on the interpretation of physical signs. There has been a shift from examinations being provided within a child protection rota, to being carried out by specialists in a Sexual Assault Referral Centre (SARC). In many places, this has meant regionalisation of the service, and in some places, provision outside the NHS. There has been a seismic cultural change in recognition of, and response to, sexual abuse in society as a whole.

Alongside this, the internet has created new ways of grooming and exploitation, and linked together those who seek to normalise CSA offending. The challenge to paediatrics (and to safeguarding and criminal justice systems), is to meet the need that these developments have exposed.

Author/s:

Gifford, J.

A Practical Guide To Conducting A Child Sexual Abuse Examination

Brian Desmarais — Mon, 23 Sep 2019 13:42:18 +0000

Date Added:

September 23, 2019

Journal/Publication:

Pediatrics and Child Health

Publication Date:

September 1, 2019

Issue:

Volume:

Pages:

448–454

URL:

A Practical Guide To Conducting A Child Sexual Abuse Examination

Type:

Community-Based Research Results

Format:

Article

DOI (1):

https://doi.org/10.1016/j.paed.2019.07.006

Keywords

child abuse

Sexual abuse

Examination

MeSH

referral and consultation

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If you work with children, then you are seeing children who have been sexually abused. Many presentations in a health setting go unrecognised.

Author/s:

Gifford, J.

Assessing and Counseling the Older Driver: A Concise Review for the Generalist Clinician

John Bayhi — Fri, 02 Aug 2019 18:51:18 +0000

Date Added:

August 9, 2019

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Mayo Foundation for Medical Education and Research

Publication Date:

August 1, 2019

Issue:

Volume:

Pages:

1582–1588

URL:

Assessing and Counseling the Older Driver: A Concise Review for the Generalist Clinician

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2019.03.023

Keywords

MeSH

referral and consultation

A concise review of issues and counseling strategies relevant to older drivers. James W. Mold, MD, MPH

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Older drivers are putting more miles on the road during their “golden years” than generations prior. Many older adults have safe driving habits, but unique age-related changes increase the risk for crash-related morbidity and mortality. Generalists are poised to assess and guide older adults' driving fitness. Although there is no uniformly accepted tool for driving fitness, assessment of 5 key domains (cognition, vision, physical function, medical comorbidities, and medications) using valid tools can help clinicians stratify older drivers into low, intermediate, and high risk for unsafe driving. Clinicians can then make recommendations about fitness to drive and appropriate referrals for rehabilitation or alternative transportation resources to optimize mobility, independence, and quality of life for older adults.

Author/s:

Hill, Larisa J.N., Pignolo, Robert J., Tung, Ericka E.