physicians

Importance Occupational distress among physicians is a highly prevalent problem that limits the effectiveness of the health care delivery system. While system change is necessary, individual physicians must also consider personal actions to mitigate occupational distress.

Objective To identify physician actions associated with large-effect-size improvements in burnout and/or professional fulfillment over a 6-month interval.

Design, Setting, and Participants This qualitative study using a mixed-methods approach recruited US physicians from the American Medical Association Physician Data file. The study used 2 quantitative online surveys that were administered 6 months apart (October 2 to November 13, 2024, and April 2 to May 16, 2025) to identify physicians with large-effect-size (≥0.8 SD) improvement in burnout and/or professional fulfillment. These physicians were subsequently recruited to participate in a qualitative study using structured interviews to identify changes they believed contributed to this improvement.

Main Outcomes and Measures Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index.

Results A total of 359 practicing physicians responded to both the baseline and follow-up surveys, among whom 87 (24.3%) had an effect size improvement of 0.8 SD or greater in burnout and/or professional fulfillment and were invited to participate in qualitative interviews. Thirty physicians (20 participants [66.7%] aged 30-49 years and 10 [33.3%] aged ≥50 years; 22 [73.3%] female) completed interviews. Thematically, these physicians reported changes in 4 categories: active (ie, intentional) work changes, passive work changes, active personal changes, and passive personal changes. A majority of participants (26 [86.7%]) reported active work and/or personal changes. Active work changes included changes to workload and work schedule, developing new skills or changing the focus of work, changing job or position, taking on or giving up a leadership position, improving efficiency, and advocating for personal needs. Active personal changes included deliberate changes in mindset, contemplative practices, taking time away, working with a therapist or coach, and prioritizing self-care. Passive work changes occurred independent of action by the individual physician and included new leadership, staffing changes, system-initiated workflow changes, and advances in technology. Passive personal changes were infrequently reported.

Conclusions and Relevance Physicians with large improvements in burnout and professional fulfillment reported specific actions at work or in their personal life that they believed led to this improvement. These findings suggest that both individual- and system-level changes may be necessary to optimize occupational well-being among physicians.

Author/s:

Tait D. Shanafelt, MD, Maryam S. Makowski, PhD, Brook Hale, et al.

Approach to mallet finger injury: Practical guide for Canadian primary care physicians

Megan George — Mon, 23 Feb 2026 17:09:08 +0000

Date Added:

February 23, 2026

Journal/Publication:

Canadian Family Physician

Publication Date:

February 1, 2026

URL:

Approach to mallet finger injury: Practical guide for Canadian primary care physicians

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.720293

Keywords

PMID (1):

41679948

MeSH

Finger Injuries* / diagnosis

Canada

Humans

Splints

Finger Injuries* / therapy

Hand Deformities

Acquired* / diagnosis

Acquired* / therapy

Acquired* / etiology

physicians

physicians, primary care

Radiography

Tendon Injuries* / diagnosis

Tendon Injuries* / therapy

A concise review of the management of patients with mallet finger injuries. James W. Mold, MD, MPH

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Objective: To provide primary care physicians with an evidence-based approach to recognizing and managing mallet finger injuries.

Sources of information: A literature search was conducted in PubMed and Google Scholar using relevant key words and subject headings. Recommendations were categorized based on clinical evidence and expert opinion using a 3-level classification system.

Main message: A mallet finger injury commonly occurs after an axial load, resulting in avulsion of the extensor tendon from the distal phalanx. This may occur with or without an avulsion fracture. Diagnosis is made clinically, with x-ray scans used to assess for an associated fracture and joint alignment. Nonsurgical management with continuous splinting for 6 to 8 weeks is the standard of care and achieves excellent outcomes even in cases of delayed presentation. Surgery referral may be considered for avulsion fractures resulting in joint subluxation, open injuries, and failure of conservative management. Untreated mallet finger injuries can lead to chronic swan-neck deformities, which may limit function.

Conclusion: Mallet finger injuries may be easily recognized and managed in the primary care settings, resulting in excellent patient outcomes without the need for specialist referral. This review should equip primary care physicians with confidence in diagnosing a mallet finger injury, initiating appropriate splinting, providing patient education, and recognizing indications for surgical referral.

Author/s:

Vincent Dinh, Marisa Market, Kevin Cheung

Approach to pelvic venous disorders

Hope Smashey — Wed, 26 Nov 2025 02:00:39 +0000

Date Added:

November 25, 2025

Publisher:

Can Fam Physician

Publication Date:

November 25, 2025

Issue:

Volume:

11-12

Pages:

699-703

URL:

Approach to pelvic venous disorders

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.711112699

Keywords

Vascular Surgical Procedures

hypertension

PMID (1):

41285637

MeSH

Vascular Surgical Procedures

Pelvis

Pelvic Pain

hypertension

A review of relatively common chronic venous abnormalities in the female pelvis that can cause LE varicosities and pelvic pain. James W. Mold, MD, MPH

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Objective: To provide a practical guide to help family physicians recognize, diagnose, and manage patients with pelvic venous disorders (PeVDs), often overlooked as causes of chronic pelvic pain and varicose veins.

Sources of information: This review is based on guidelines from the American Venous Forum, the Society for Vascular Surgery, the American Vein and Lymphatic Society, the Society of Interventional Radiology, and the European Society for Vascular Surgery.

Main message: PeVDs are common, though frequently misdiagnosed, causes of chronic pelvic pain and varicose veins predominantly in female patients. These conditions arise from venous reflux or obstruction, which can cause varicose veins and venous hypertension in the renal hilum, pelvis, perineum, and lower extremities. Family physicians should recognize the clinical signs of PeVDs and use appropriate imaging to confirm diagnoses. Interventional treatments, including embolization and stenting, are effective for symptom management and improving patient outcomes.

Conclusion: Early recognition of patients with PeVDs by family physicians is crucial for timely and effective treatment. By using appropriate diagnostic tools and making timely referrals, physicians can substantially improve patients' quality of life.

Author/s:

Andrew D Brown

Practical Recommendations for Minimizing Pain and Anxiety with IUD Insertion

Erin Blanchette — Mon, 24 Mar 2025 16:11:24 +0000

Date Added:

March 24, 2025

Journal/Publication:

Journal of the American Board of Family Medicine

Publisher:

American Board of Family Medicine

Publication Date:

November 1, 2024

Issue:

Volume:

Pages:

1150-1155

URL:

Practical Recommendations for Minimizing Pain and Anxiety with IUD Insertion

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.3122/jabfm.2024.240079R1

Keywords

PMID (1):

40118554

MeSH

Intrauterine Devices* / adverse effects

Intrauterine Devices

female

Contraceptive Agents, Female

Pain / prevention & control

pain management

Lidocaine

Prilocaine Drug Combination

An evidence-based review of methods for reducing pain during IUD insertion. Many of these would probably work as well for other painful procedures. James W. Mold, MD, MPH

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Background: Intrauterine devices (IUDs) are one of the most effective, long-lasting, and convenient contraceptive methods available in the United States. Unfortunately, the anticipated pain and anxiety associated with an IUD insertion procedure deter many people from using this contraceptive method.

Methods: A literature review was conducted on PubMed by searching the terms “IUD insertion”, “pain management”, “anxiety”, “gynecologic procedures”. The Cochrane database was also searched for reviews about pain management methods during IUD insertions. Findings were summarized using the American Academy of Family Physicians’ Strength of Recommendation Taxonomy (SORT) scale.

Results: Pharmacologic methods that can be used to reduce pain with IUD insertion include naproxen, tramadol, lidocaine paracervical blocks, 10% lidocaine spray, lidocaine-prilocaine cream, and EMLA cream. Non-pharmacologic methods for reducing pain or anxiety during gynecologic procedures include pre-insertion counseling, “verbal analgesia”, lavender aromatherapy, distraction with music or television, using Valsalva maneuver instead of tenaculum during IUD insertion, and use of heating pad during procedure.

Conclusion: Moderately effective pharmacologic and non-pharmacologic methods exist for reducing pain and anxiety with IUD insertion. These treatment methods should be offered to create a more comfortable experience for patients. Additional research is needed to determine the comparative efficacy of these methods.

Author/s:

Viktoriya Ovsepyan, Petra Kelsey, Ann E Evensen

Referred otalgia: Common causes and evidence-based strategies for assessment and management

Erin Blanchette — Mon, 27 Nov 2023 18:39:54 +0000

Date Added:

November 27, 2023

Journal/Publication:

Canadian Family Physician

Publisher:

College of Family Physicians of Canada

Publication Date:

November 14, 2023

Issue:

Volume:

Pages:

757-761

URL:

Referred otalgia: Common causes and evidence-based strategies for assessment and management

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.6911757

Keywords

PMID (1):

37963787

MeSH

A concise summary of the various causes of nonotologic ear pain (referred from other structures). James W. Mold, MD, MPH

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Objective: To provide family physicians and general otolaryngologists with a practical, evidence-based, and comprehensive approach to the management of patients presenting with suspected referred otalgia.

Sources of information: The approach described is a review based on the authors' clinical practices along with research and clinical review articles published between 2000 and 2020. MEDLINE and PubMed were searched using the terms otalgia, referred otalgia, and secondary otalgia. Current guidelines for the management of referred otalgia were also reviewed.

Main message: Otalgia is defined as pain localized to the ear. It is one of the most common head and neck presentations in primary care, otolaryngology, and emergency medicine. Secondary otalgia arises from nonotologic pathology and represents nearly 50% of otalgia cases. Otalgia in the absence of other otologic symptoms is highly indicative of a secondary cause. A thorough assessment of patients presenting with referred otalgia requires an understanding of the possible causes of this condition, including dental and oral mucosal pathologies, temporomandibular joint disorders, cervical spine pathology, sinusitis, upper airway infection, and reflux, as well as head and neck malignancy. This paper aims to highlight the most common causes of referred otalgia, their presentations, and initial options for assessment and management.

Conclusion: The prevalence of referred otalgia makes this an important condition for family physicians to be able to assess, manage, and triage based on patient presentation and examination. Understanding the common causes of referred otalgia will help reduce wait times for specialist assessment and allow ease and speed of access to management options for patients in community clinics.

Author/s:

Fatemeh Ramazani, Charmaine Szalay-Anderson, Arthur Volpato Batista, Phillip Park, Euna Hwang, Justin Chau, Justin Lui

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.

Mobile Telemedicine for Buprenorphine Treatment in Rural Populations With Opioid Use Disorder

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

Date Added:

September 3, 2021

Type:

Clinical Research Results

DOI (1):

10.1001/jamanetworkopen.2021.18487

A report and description of the use of telemedicine and mobile services to help people in rural areas with substance abuse challenges.

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Importance
The demand for medications for opioid use disorder (MOUD) in rural US counties far outweighs their availability. Novel approaches to extend treatment capacity include telemedicine (TM) and mobile treatment on demand; however, their combined use has not been reported or evaluated.

Objective
To evaluate the use of a TM mobile treatment unit (TM-MTU) to improve access to MOUD for individuals living in an underserved rural area.

Design, Setting, and Participants
This quality improvement study evaluated data collected from adult outpatients with a diagnosis of OUD enrolled in the TM-MTU initiative from February 2019 (program inception) to June 2020. Program staff traveled to rural areas in a modified recreational vehicle equipped with medical, videoconferencing, and data collection devices. Patients were virtually connected with physicians based more than 70 miles (112 km) away. Data analysis was performed from June to October 2020.

Intervention
Patients received buprenorphine prescriptions after initial teleconsultation and follow-up visits from a study physician specialized in addiction psychiatry and medicine.

Main Outcomes and Measures
The primary outcome was 3-month treatment retention, and the secondary outcome was opioid-positive urine screens. Exploratory outcomes included use of other drugs and patients’ travel distance to treatment.

Results
A total of 118 patients were enrolled in treatment, of whom 94 were seen for follow-up treatment predominantly (at least 2 of 3 visits [>50%]) on the TM-MTU; only those 94 patients’ data are considered in all analyses. The mean (SD) age of patients was 36.53 (9.78) years, 59 (62.77%) were men, 71 (75.53%) identified as White, and 90 (95.74%) were of non-Hispanic ethnicity. Fifty-five patients (58.51%) were retained in treatment by 3 months (90 days) after baseline. Opioid use was reduced by 32.84% at 3 months, compared with baseline, and was negatively associated with treatment duration (F = 12.69; P = .001). In addition, compared with the nearest brick-and-mortar treatment location, TM-MTU treatment was a mean of 6.52 miles (range, 0.10-58.70 miles) (10.43 km; range, 0.16-93.92 km) and a mean of 10 minutes (range, 1-49 minutes) closer for patients.

Conclusions and Relevance
These data demonstrate the feasibility of combining TM with mobile treatment, with outcomes (retention and opioid use) similar to those obtained from office-based TM MOUD programs. By implementing a traveling virtual platform, this clinical paradigm not only helps fill the void of rural MOUD practitioners but also facilitates access to underserved populations who are less likely to reach traditional medical settings, with critical relevance in the context of the COVID-19 pandemic.

Author/s:

Weintraub, E., Seneviratne, C., Anane, J.

Patient Questions Surrounding Mask Use for Prevention of COVID-19 and Physician Answers from an Evidence-Based Perspective: a Narrative Review

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

Date Added:

September 3, 2021

Type:

Patient Education Materials

DOI (1):

10.1007/s11606-020-06324-w

MeSH

Evidence-based answers to patients’ questions about masks to prevent the spread of COVID-19.

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Recent mandates to wear masks in public places across the USA combined with conflicting messaging from the media and government agencies have generated a lot of patient questions surrounding the appropriate use and efficacy of cloth masks. Here, we have organized the evidence in the context of real patient questions and have provided example answers from a physician’s perspective. The purpose of this review is to offer healthcare providers with examples of how to respond to patient questions about masks in a way that encourages responsible decision-making. We conclude, based on the evidence showing a benefit for cloth masks and the recent reports supporting a role for aerosols in the transmission of SARS-CoV-2, that cloth masks will be effective when used correctly. We further assert that stronger public messaging surrounding cloth masks in the community setting is needed, and should specify that 2–3 layer, fitted face masks be worn at all times in public as another layer of protection in addition to social distancing, not just when social distancing cannot be maintained.

Author/s:

Martinez, J. A., Miller, R. H., Martinez, R. A.

APOE ɛ4 Allele Testing and Risk of Alzheimer Disease

Devin Evans — Thu, 21 Jan 2021 06:00:00 +0000

Date Added:

January 21, 2021

Journal/Publication:

The Journal of the American Medical Association

Publication Date:

January 14, 2021

URL:

APOE ɛ4 Allele Testing and Risk of Alzheimer Disease

Type:

Clinical Decision Aids

Format:

Article

DOI (1):

10.1001/jama.2020.15085

Keywords

PMID (1):

33443531

MeSH

A brief review of the interpretation of APOE tests for diagnosing and predicting dementia of the Alzheimer’s type. James W. Mold, MD, MPH

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A 64-year-old man presented with concern about an abnormal genetic test result for apolipoprotein E (APOE) obtained through his primary care physician. He reported forgetfulness and word-finding difficulties for 3 years but performed all activities of daily living independently and was generally healthy. His father and maternal great aunt developed dementia in their 70s. Physical (including neurologic) examination, basic laboratory studies, and brain magnetic resonance imaging results were normal. The Short Test of Mental Status (STMS) score was 33 (maximal attainable score of 38 indicates best performance). Neuropsychological assessment showed average to above-average performance in all cognitive domains, accounting for age and education. Results of his genetic testing for APOE were reported as follows: “This individual possesses an apolipoprotein E genotype (3 and 4) that indicates, with high specificity, that Alzheimer’s disease is the cause of or a contributor to the observed dementia.”

Author/s:

Choudhury, Parichita, Ramanan, Vijay K., Boeve, Bradley F.

Persistent Value of the Stethoscope in the Age of COVID-19

Brian Desmarais — Mon, 22 Jun 2020 15:09:57 +0000

Date Added:

June 22, 2020

Journal/Publication:

The American Journal of Medicine

Publication Date:

June 19, 2020

URL:

Persistent Value of the Stethoscope in the Age of COVID-19

Type:

Best Local Practices

Format:

Article

DOI (1):

https://doi.org/10.1016/j.amjmed.2020.05.018

Keywords

MeSH

Physician-Patient Relations

severe acute respiratory syndrome coronavirus 2

An interesting review of the history and future of the stethoscope including tips for disinfecting one. James W. Mold, MD, MPH

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Abstract

The stethoscope has long been at the center of patient care as well as a symbol of the physician-patient relationship. While advancements in other diagnostic modalities have allowed for more efficient and accurate diagnosis, the stethoscope has evolved in parallel to address the needs of the modern era of medicine. These advancements include sound visualization, ambient noise reduction/cancellation, Bluetooth™ transmission, and computer algorithm diagnostic support. However, despite these advancements, the ever-changing climate of infection prevention, especially in the wake of the COVID-19 pandemic, has led many to question the stethoscope as a vector for infectious diseases. Stethoscopes have been reported to harbor bacteria with contamination levels comparable to a physician's hand. Although disinfection is recommended, stethoscope hygiene compliance remains low. In addition, disinfectants may not be completely effective in eliminating microorganisms. Despite these risks, the growing technological integration with the stethoscope continues to make it a highly valuable tool. Rather than casting our valuable tool and symbol of medicine aside, we must create and implement an effective method of stethoscope hygiene to keep patients safe.

•Stethoscopes are clinically valuable and integral to the doctor-patient connection

•Technological advancement will augment the utility of the stethoscope

•The stethoscope has high utility for assessment of COVID-19 patients

•Pathogen contamination in light of COVID-19 is a concern for the stethoscope

•Innovations in stethoscope hygiene will allow safe auscultation

Author/s:

Vasudevan, R.S., Horiuchi, Y., Torianni, F.J., Cotter, B., Maisel, S.M., Dadwal, S.S., Gaynes, R., Maisel, A.S.

Coding for Coronavirus: NEW Guidance Replaces the Rule of 1 Month Ago

Brian Desmarais — Thu, 02 Apr 2020 02:51:06 +0000

Date Added:

April 1, 2020

Journal/Publication:

Medscape Family Medicine

Publication Date:

March 30, 2020

URL:

Coding for Coronavirus: NEW Guidance Replaces the Rule of 1 Month Ago

Type:

Practice Management Reviews and Guidelines

Format:

Web Page

Keywords

MeSH

International Classification of Diseases

health personnel

physicians

Centers for Disease Control and Prevention

U.S.

A new ICD-10 code, U07.1, has been created for confirmed cases of COVID19. Additional codes can be added for complications like pneumonia. James W. Mold, MD, MPH

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Not available.

Author/s:

Nicoletti, B.

COVID-19 Resources

Brian Desmarais — Tue, 24 Mar 2020 15:40:39 +0000

Date Added:

March 24, 2020

Publisher:

OU Medicine

Publication Date:

March 19, 2020

URL:

COVID-19 Resources

Type:

Best Local Practices

Format:

Web Page

MeSH

COVID-19

severe acute respiratory syndrome coronavirus 2

physicians

health resources

Policy

COVID19 policies, procedures, and resources developed by OU Physicians. James W. Mold, MD, MPH

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Not available.

Author/s:

OU Physicians

Recommended Adult Immunization Schedule, United States, 2020

Brian Desmarais — Tue, 04 Feb 2020 15:28:01 +0000

Date Added:

February 4, 2020

Journal/Publication:

Annals of Internal Medicine

Publication Date:

February 4, 2020

Volume:

Online

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M20-0046

Keywords

guidelines

adult immunization

MeSH

Immunization Schedule

Centers for Disease Control and Prevention

Centers for Medicare and Medicaid Services (U.S.)

Adults

2020 guidelines for adult immunizations with printable charts. James W. Mold, MD, MPH

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In October 2019, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Adult Immunization Schedule for Ages 19 Years or Older, United States, 2020. The 2020 adult immunization schedule, available at www.cdc.gov/vaccines/schedules/hcp/imz/adult.html, summarizes ACIP recommendations in 2 tables and accompanying notes (Figure). The full ACIP recommendations for each vaccine are available at www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2020 schedule has also been approved by the director of the Centers for Disease Control and Prevention (CDC) and by the American College of Physicians (www.acponline.org), American Academy of Family Physicians (www.aafp.org), American College of Obstetricians and Gynecologists (www.acog.org), and American College of Nurse-Midwives (www.midwife.org).

Author/s:

Freedman, M., Kroger, A., Hunter, P., Ault, K.A.

Testosterone Treatment in Adult Men With Age-Related Low Testosterone: A Clinical Guideline From the American College of Physicians

John Bayhi — Tue, 07 Jan 2020 19:22:41 +0000

Date Added:

January 7, 2020

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

January 7, 2020

URL:

Testosterone Treatment in Adult Men With Age-Related Low Testosterone: A Clinical Guideline From the American College of Physicians

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M19-0882

Keywords

testosterone

guidelines

age-related testosterone deficiency

PMID (1):

31905405

MeSH

depressive disorder, major

Sexual Dysfunction

Physiological

Cognition

cardiovascular diseases

It appears that testosterone replacement in men with documented age-related testosterone deficiency may have small benefits in terms of sexual function and quality of life with no effect on physical function and no increase in significant adverse events. James W. Mold, MD, MPH

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DESCRIPTION:

The American College of Physicians (ACP) developed this guideline to provide clinical recommendations based on the current evidence of the benefits and harms of testosterone treatment in adult men with age-related low testosterone. This guideline is endorsed by the American Academy of Family Physicians.

METHODS:

The ACP Clinical Guidelines Committee based these recommendations on a systematic review on the efficacy and safety of testosterone treatment in adult men with age-related low testosterone. Clinical outcomes were evaluated by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system and included sexual function, physical function, quality of life, energy and vitality, depression, cognition, serious adverse events, major adverse cardiovascular events, and other adverse events.

TARGET AUDIENCE AND PATIENT POPULATION:

The target audience includes all clinicians, and the target patient population includes adult men with age-related low testosterone.

RECOMMENDATION 1A:

ACP suggests that clinicians discuss whether to initiate testosterone treatment in men with age-related low testosterone with sexual dysfunction who want to improve sexual function (conditional recommendation; low-certainty evidence). The discussion should include the potential benefits, harms, costs, and patient's preferences.

RECOMMENDATION 1B:

ACP suggests that clinicians should reevaluate symptoms within 12 months and periodically thereafter. Clinicians should discontinue testosterone treatment in men with age-related low testosterone with sexual dysfunction in whom there is no improvement in sexual function (conditional recommendation; low-certainty evidence).

RECOMMENDATION 1C:

ACP suggests that clinicians consider intramuscular rather than transdermal formulations when initiating testosterone treatment to improve sexual function in men with age-related low testosterone, as costs are considerably lower for the intramuscular formulation and clinical effectiveness and harms are similar.

RECOMMENDATION 2:

ACP suggests that clinicians not initiate testosterone treatment in men with age-related low testosterone to improve energy, vitality, physical function, or cognition (conditional recommendation; low-certainty evidence).

Author/s:

Qaseem, A., Horwitch, CA, Vijan, S, Etxeandia-Ikobaltzeta, I, Kansagara, D, Clinical Guidelines Committee of the American College of Physicians

Physician Stress and Burnout

John Bayhi — Wed, 18 Sep 2019 16:49:32 +0000

Date Added:

September 18, 2019

Journal/Publication:

The American Journal of Medicine

Publisher:

Elsevier Inc

Publication Date:

September 11, 2019

URL:

Physician Stress and Burnout

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.amjmed.2019.08.034

Keywords

PMID (1):

31520624

MeSH

burnout, professional

A review of physician burnout and what can be done about it. James W. Mold, MD, MPH

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Tens (or hundreds) of thousands of Americans die each year as a result of preventable medical errors. Changes in the practice and business of medicine have caused some to question whether burnout among physicians and other healthcare providers may adversely affect patient outcomes. A clear consensus supports the contention that burnout affects patients, albeit with low quality objective data. The psychological and physical impact on physicians and other providers is quite clear however, and the impact on the physician workforce (where large shortages are projected) is yet another cause for concern. We have all heard the airplane safety announcement remind us to "please put on your own oxygen mask first before assisting others." But, like many airline passengers (very few of whom use oxygen masks correctly when they are needed), physicians often do not recognize symptoms of burnout or depression, and even less often do they seek help. We detail causes and consequences of physician burnout and propose solutions to increase physician work satisfaction.

Author/s:

Yates, SW