Understanding type 2 diabetes mellitus screening practices among primary care physicians: a qualitative chart-stimulated recall study.

BACKGROUND: Early diagnosis and treatment of prediabetes and type 2 diabetes mellitus (T2DM) can prevent future health problems, yet many individuals with these conditions are undiagnosed. This could be due, in part, to primary care physicians' (PCP) screening practices, about which little is known. The objectives of this study were to identify factors that influence PCPs' decisions to screen patients for T2DM and to characterize their interpretation and communication of screening test results to patients. METHODS: We conducted semi-structured chart-stimulated recall interviews with 20 University of Michigan Health System (UMHS) primary care physicians. PCPs were asked about their recent decisions to screen or not screen 134 purposively sampled non-diabetic patients who met American Diabetes Association criteria for screening for T2DM. Interviews were audio-recorded, transcribed, and analyzed using qualitative directed content analysis. Data on patient demographic characteristics and comorbidities were abstracted from the electronic health record. RESULTS: The most common reasons PCPs gave for not screening 63 patients for T2DM were knowledge of a previously normal screening test (49%) and a visit for reasons other than a health maintenance examination (48%). The most common reasons PCPs gave for screening 71 patients for T2DM were knowledge of a previously abnormal screening test (49%), and patients' weight (42%) and age (38%). PCPs correctly interpreted 89% of screening test results and communicated 95% of test results to patients. Among 24 patients found to have prediabetes, PCPs usually (58%) recommended weight loss and increased physical activity but never recommended participation in a Diabetes Prevention Program or use of metformin. CONCLUSIONS: Previous screening test results, visit types, and patients' weight and age influenced PCPs' decisions to screen for T2DM. When patients were screened, test results were generally correctly interpreted and consistently communicated. Recommendations to patients with prediabetes could better reflect evidence-based strategies to prevent T2DM.

Use of Telehealth in Pediatrics.

This article discusses the use of telehealth in the role of pediatric health care. Management of common pediatric complaints and concerns are discussed in the context of a virtual setting. Benefits, as well as limitations and challenges, and the future of telehealth within the care of pediatric patient are reviewed.

Should ultrasound-guided needle fenestration be considered as a treatment option for recalcitrant patellar tendinopathy? A retrospective study of 47 cases.

OBJECTIVE: To report the retrospective results of ultrasound-guided needle fenestration for the treatment of recalcitrant patellar tendinopathy. DESIGN: Retrospective follow-up study. SETTING: University outpatient sports medicine clinic. PATIENTS: Forty-seven patellar tendons in 32 patients (26 men and 6 women; mean age, 26 years) with recalcitrant patellar tendinopathy. Diagnosis made via history, physical examination, and sonographic examination. INTERVENTION: Ultrasound-guided needle fenestration after failure of conservative management. MAIN OUTCOME MEASURES: Pre-treatment and 4-week clinical follow-up determination of functional activity score. Phone follow-up determination of best achievable level of activity and satisfaction score of the procedure. RESULTS: Average time to follow-up was 45 months. Seventy-two percent of patients reported excellent or good results when questioned regarding return to activity. Twenty-eight percent of patients were unable to return to their desired activity level. Six patients subsequently underwent surgical treatment. One athlete underwent surgery to repair a patellar tendon rupture that occurred 6 weeks after the procedure. Eighty-one percent of patients reported excellent or good satisfaction scores. CONCLUSIONS: Ultrasound-guided needle fenestration warrants further investigation for the treatment of recalcitrant patellar tendinopathy.

Dermatologic Manifestations of Systemic Diseases.

Dermatologic complaints are encountered frequently by the primary care provider. Patients often are required as well as want to see their primary care provider before referral to a specialist. Therefore, primary care providers must be skilled in a variety of topics including dermatology. Certain dermatologic manifestations are associated with, or indicative of, systemic diseases. Primary care providers must be knowledgeable in diagnosis, evaluation, and treatment of dermatologic conditions, as well as when to appropriately refer. This article reviews common dermatologic manifestations of systemic diseases.