Missouri medicine最新文献

One in six youth has a neurodevelopmental disability (NDD), and autism diagnostic rates continue to rise. Before and after a diagnosis, families need trusted sources of guidance to navigate co-occurring medical and psychological conditions, and to manage unique stressors including transition to adulthood. However, medical professionals from all specialty areas struggle to identify resources to support the complex psychosocial and healthcare needs of these patients and their families. This primer on psychosocial supports for youth with autism will explore the major mental and physical health stressors faced by affected youth and families, and discuss opportunities for primary care and other providers to provide resources and empower their patients. Through awareness of key challenges and resources, non-specialist providers can integrate autism-specific supports into their regular practice. These same approaches will also allow providers to offer more holistic care for the broader NDD patient community as well.

Following the COVID-19 pandemic, the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association declared a national emergency in child and adolescent mental health. Rates of anxiety and depression in youth continue at unprecedented levels, contributing to rising numbers of suicide attempts and lowered school attendance. Though many medical providers are trained to assess and provide recommendations for anxiety and depression, many report feeling ill-equipped to address these concerns in a timely, feasible, and effective manner. We review the existing literature on screening for anxiety and depression in the medical setting and provide evidence-based tools for providers to support patients, with acknowledgments of special populations. Additionally, we review multi-disciplinary models of treatment, such as one used by the Depression and Anxiety in Youth (DAY) program at Children's Mercy Kansas City.

The opioid epidemic claims tens of thousands of lives annually in the United States (US) where opioids are prescribed more per capita than in any other country. Primary care providers contribute to nearly half of these prescriptions, often for chronic non-cancer pain conditions such as back, hip, and knee pain. Despite widespread use, evidence suggests that opioids do not improve pain control for chronic non-cancer musculoskeletal pain. This study aimed to assess whether an opioid prescription in the three months preceding internal medicine primary care appointments was associated with lower pain levels, as reported on a 1 to 10 scale during medical assistant check-ins, among patients with chronic non-cancer musculoskeletal pain. Using a cross-sectional design, we analyzed pain scores for adult patients who had been prescribed opioids versus those who had not. Our findings revealed no statistically significant difference in pain levels between the two groups, with both opioid and non-opioid users reporting similar median pain scores. These results align with existing evidence, reinforcing the notion that opioids offer no substantial advantage in pain management for chronic musculoskeletal pain.

Objective: To understand the perceptions, knowledge, and opportunities to improve antibiotic prescribing practices among outpatient providers.

Methodology: We disseminated a survey to a convenience sample of primary care and internal medicine physicians and mid-level providers practicing in the state of Missouri.

Results: Sixty-seven providers completed the survey. Most (64%) providers reported reviewing best practice guidelines and educational materials on a regular basis. Providers were most interested in patient-facing educational materials that would help support best practices. However, substantial variability existed in responses about antibiotic prescribing; some (15%) respondents stated that they rarely review guidelines or use antibiotic stewardship resources. Providers felt that any feedback about antibiotic prescribing practices should be provided via email and should focus on reducing antibiotic use for viral conditions.

Conclusion: Missouri survey respondents generally support appropriate antibiotic use to address antibiotic resistance. However, findings also suggest that delivering resources to targeted populations of over-prescribers may be beneficial. Future interventions should include physician-endorsed education to support safe antibiotic use and explore electronic feedback for viral conditions.

Antibiotic resistance is driven by inappropriate antibiotic use. Multi-drug resistance is a rising concern in Gram-negative bacteria. Prompt recognition and appropriate antibiotics are needed for improving outcomes. This is a practice primer for clinicians in the management of resistant infections that summarizes mechanisms, treatment, updates and the spectrum of activity for newer antibiotics, most relevant to current clinical practice.