Optimizing Health for Complex Adults in Primary Care: Current Challenges and a Way Forward

As the population ages, the quantity and complexity of comorbidities only increases in the primary care setting. Health systems strive to improve quality of care and enhance cost savings, but current administrative and payment systems do not easily support the implementation of existing evidence and best practices for multimorbid adults in most primary care offices. This perspectives piece sets forth a research agenda in the area of implementation science at the intersection of geriatrics and general internal medicine. We challenge academic medical centers, medical societies, journals, and funders to actively value and support investigation in this area as much as traditional research pathways.     

Precision medicine in chronic disease management: The multiple sclerosis BioScreen

We present a precision medicine application developed for multiple sclerosis (MS): the MS BioScreen. This new tool addresses the challenges of dynamic management of a complex chronic disease; the interaction of clinicians and patients with such a tool illustrates the extent to which translational digital medicine—that is, the application of information technology to medicine—has the potential to radically transform medical practice. We introduce 3 key evolutionary phases in displaying data to health care providers, patients, and researchers: visualization (accessing data), contextualization (understanding the data), and actionable interpretation (real‐time use of the data to assist decision making). Together, these form the stepping stones that are expected to accelerate standardization of data across platforms, promote evidence‐based medicine, support shared decision making, and ultimately lead to improved outcomes. Ann Neurol 2014;76:633–642     

Long-Term Follow-Up After Complete Resection of Well-Differentiated Cancer Confined to the Thyroid Gland

Background  

Papillary or follicular thyroid carcinomas exhibit a relatively benign course. Hence, long-term follow-up studies with well-defined disease stages and treatment details are needed to evaluate treatment strategies.     

A Survey of Oregon Emergency Physicians to Assess Mandatory Reporting Knowledge and Reporting Patterns Regarding Intoxicated Drivers in the State of Oregon

Objectives: To assess emergency physician reporting patterns in Oregon before and after the passage of a mandatory intoxicated driving reporting law. Methods: A one‐page survey was mailed to 504 emergency physicians in Oregon in April 2004. Data on reporting frequency were collected using a four‐point ordinal scale regarding motor vehicle crash–involved drivers (MIDs) and intoxicated persons attempting to drive away from the emergency department (DAEDs). Paired observations were assessed for a stated increase in reporting activity following passage of the law using the Wilcoxon signed‐rank test. Associations of postlaw reporting and demographic and knowledge factors were sought using Spearman rank correlation analysis. Results: Of the 504 surveys mailed, 298 (59%) were adequate for analysis. Many respondents (57%) were already aware of the law. Most (92%) agreed that physicians should be mandated to report some crimes. MIDs were always reported by 18% of physicians before the law and by 47% afterward, whereas DAEDs were always reported by 56% of physicians before the law and by 69% afterward. Emergency medicine–trained physicians, higher emergency department census, and increased years of experience were associated with a significantly higher increase in reporting pattern after passage of the law for both MIDs and DAEDs. Conclusions: Although 44% of responding emergency physicians in Oregon were unaware of a mandated reporting law for intoxicated drivers presenting to the ED, most physicians stated an increase in their reporting practice.     

Intrarenal Vascular Changes in Adult Patients with Recurrent Haematuria and Loin Pain--A Clinical, Histological and Angiographic Study

Clinical features have been correlated with renal function,histology and selective renal angiography in 19 patients withrecurrent painless haematuria, recurrent loin pain, or bothhaematuria and loin pain in whom urinary infection, calculiand anatomical abnormalities of the urinary tract had been excluded.No deterioration in renal function was observed in any patientover periods of up to nine years. Although all patients showedsimilar glomerular changes histologically, consisting of focaland segmental mesangial thickening and proliferation and periglomerularfibrosis, mild tubular damage was more common in those withloin pain. All patients with loin pain whether or not they hadhaematuria, had abnormal renal angiograms consisting of focalor generalized vascular lesions sometimes associated with corticalinfarcts. The possible aetiological factors are discussed withparticular reference to oestrogen-containing compounds. ¹Present address: Wessex Regional Renal Unit, St. Mary's GeneralHospital, Portsmouth. ²Present address: Renal Unit, Walsgrave Hospital, Coventry.