George Bergus
The University of Iowa, College of Medicine, Department Member
Tienda online donde Comprar Medical Decision Making al precio 38,28 € de Alan Schwartz | George Bergus, tienda de Libros de Medicina, Libros de Medicina Familiar y Comunitaria/General - Medicina general
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ABSTRACT
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Many of the terms used in medical decision making are foreign to clinicians. This problem creates a barrier that can prevent physicians from acquiring these new clinical tools. This glossary contains definitions of the most common terms... more
Many of the terms used in medical decision making are foreign to clinicians. This problem creates a barrier that can prevent physicians from acquiring these new clinical tools. This glossary contains definitions of the most common terms as well as examples of their usage by using Down syndrome as the illustrative condition.
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Background and Objectives: Identifying underperforming residents and helping them become fully competent physicians is an important faculty responsibility. The process to identify and remediate these learners varies greatly between... more
Background and Objectives: Identifying underperforming residents and helping them become fully competent physicians is an important faculty responsibility. The process to identify and remediate these learners varies greatly between programs. The objective of this study was to evaluate the remediation landscape in family medicine residency programs by investigating resident remediation characteristics, tools to improve the process, and remediation challenges. Methods: This study analyzed responses from the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2017. Survey questions included topics on faculty remediation training, remediation prevalence, tools for remediation, and barriers to remediation. Results: Two hundred sixty-seven of 503 program directors completed our survey (53% response rate). Most residency programs (245/264, 93%) had at least one resident undergoing remediation in the last 3 years. ...
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Risk factors for pulmonary embolism include immobilization, trauma and surgery, particularly for hip fracture. Patients may present with acute respiratory symptoms, including tachypnea, tachycardia and rales. Chest radiographs and... more
Risk factors for pulmonary embolism include immobilization, trauma and surgery, particularly for hip fracture. Patients may present with acute respiratory symptoms, including tachypnea, tachycardia and rales. Chest radiographs and clinical and laboratory findings alone cannot provide a firm diagnosis. A completely normal chest radiograph may be seen in up to 40 percent of patients with pulmonary embolism, and as many as 30 percent of persons with pulmonary embolism and no prior cardiopulmonary disease will have a PaO2 greater than 80 mm Hg. The ventilation/perfusion (V/Q) lung scan is central to guiding clinical decisions. V/Q scans interpreted as either normal, near normal or high probability are reasonably diagnostic. A low probability V/Q scan can exclude the diagnosis of pulmonary embolism only if the patient has a clinically low probability of pulmonary embolism. Intermediate V/Q scans are not diagnostic and call for further evaluation. Compression ultrasonography is sensitive ...
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Low-dose thiazide-type diuretics are recommended as initial therapy for most hypertensive patients. Chlorthalidone has significantly reduced stroke and cardiovascular end points in several landmark trials; however, hydrochlorothiazide... more
Low-dose thiazide-type diuretics are recommended as initial therapy for most hypertensive patients. Chlorthalidone has significantly reduced stroke and cardiovascular end points in several landmark trials; however, hydrochlorothiazide remains favored in practice. Most clinicians assume that the drugs are interchangeable, but their antihypertensive effects at lower doses have not been directly compared. We conducted a randomized, single-blinded, 8-week active treatment, crossover study comparing chlorthalidone 12.5 mg/day (force-titrated to 25 mg/day) and hydrochlorothiazide 25 mg/day (force-titrated to 50 mg/day) in untreated hypertensive patients. The main outcome, 24-hour ambulatory blood pressure (BP) monitoring, was assessed at baseline and week 8, along with standard office BP readings every 2 weeks. Thirty patients completed the first active treatment period, whereas 24 patients completed both. An order–drug–time interaction was observed with chlorthalidone; therefore, data fr...
Research Interests: Drug interactions, Medicine, Humans, Hypertension, Low Dose, and 15 moreBlood Pressure, Female, Male, Hydrochlorothiazide, Clinical Sciences, Middle Aged, Blood Pressure Monitoring, Adult, Time Factors, Cross-Over Studies, Ambulatory Blood Pressure, Recommended Dose, Antihypertensive agents, Cardiovascular medicine and haematology, and antihypertensive therapy
Atherosclerotic renal artery stenosis is a common clinical problem for which the optimal therapeutic strategy remains to be defined. However, renal artery stenting procedures have significantly increased as one approach to treat this... more
Atherosclerotic renal artery stenosis is a common clinical problem for which the optimal therapeutic strategy remains to be defined. However, renal artery stenting procedures have significantly increased as one approach to treat this clinical problem. Despite improvements in device design and technical performance of the procedure, the benefits and results of randomized clinical trials of renal artery stenting as a therapy remain confusing. Understanding the epidemiology, pathophysiology and natural history of renal artery stenosis are central to improving the outcomes of renal artery stenting. Developing both noninvasive and invasive predictive tools to better identify which patient will respond to renal revascularization will also be beneficial. In this article, we will present an overview of atherosclerotic renal artery disease. The results of renal artery stenting will be discussed and from this, the available noninvasive and invasive tools available to assess the clinical and hemodynamic significance of renal artery stenosis will be presented.
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ABSTRACT This is a summary, including tables of key findings and quality of included trials of a Cochrane review, published in this issue of EBCH, first published as: Gonzalez U, Seaton T, Bergus G, Jacobson J, Martínez-Monzón C. Systemic... more
ABSTRACT This is a summary, including tables of key findings and quality of included trials of a Cochrane review, published in this issue of EBCH, first published as: Gonzalez U, Seaton T, Bergus G, Jacobson J, Martínez-Monzón C. Systemic antifungal therapy for tinea capitis in children. Cochrane Database of Systematic Reviews 2007, Issue 4. Art No.: CD004685.DOI:10.1002/14651858.CD004685.pub2.Further information for this Cochrane review is available in this issue of EBCH in the accompanying Commentary. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration
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In objective standardized clinical examination (OSCE) of infants, real infants are generally not used. Instead, the standardized patient portrays a parent who answers a... more
In objective standardized clinical examination (OSCE) of infants, real infants are generally not used. Instead, the standardized patient portrays a parent who answers a student's questions, and there is no physical examination. One way to assess physical examination skills in these encounters is to have students demonstrate the appropriate examination on a mannequin. But before using this approach, we wanted to assess whether having students examine mannequins affects their history-collecting or communication skills. Third-year medical students were randomized to 2 versions of an infant OSCE case. During the encounter, controls were handed a printed listing of all physical examination (PE) findings. Students in the mannequin group were told relevant PE findings only after the students had examined a part of the mannequin. Student performances on the OSCE case and perceptions about the case were compared. Thirty-two students were in the control group, and 35 students examined mannequins. No differences were found in total case score (P = .78), or on history-gathering skills (P = .86) and communication skills subscales (P = .78). In addition, questionnaires completed by students after the encounter indicated that the infant mannequins did not affect student perceptions about the realism of the case (P = .91). Student performances at collecting the clinical history or communicating with the standardized patient were not adversely affected by inclusion of an infant mannequin. This suggests mannequins can be used to assess students' knowledge of the relevant case-specific PE without adverse effect.
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The practice of Evidence-based Medicine requires that clinicians assess the validity of published research and then apply the results to patient care. We wanted to assess whether our soon-to-graduate medical students could appraise and... more
The practice of Evidence-based Medicine requires that clinicians assess the validity of published research and then apply the results to patient care. We wanted to assess whether our soon-to-graduate medical students could appraise and apply research about a diagnostic test within a clinical context and to compare our students with peers trained at other institutions. 4th year medical students who previously had demonstrated competency at probability revision and just starting first-year Internal Medicine residents were used for this research. Following an encounter with a simulated patient, subjects critically appraised a paper about an applicable diagnostic test and revised the patient's pretest probability given the test result. The medical students and residents demonstrated similar skills at critical appraisal, correctly answering 4.7 and 4.9, respectively, of 6 questions (p = 0.67). Only one out of 28 (3%) medical students and none of the 15 residents were able to correctl...
Research Interests: Psychiatry, Evidence Based Medicine, Applied Research, Heart Failure, Medical Students, and 15 moreHumans, Internal Medicine, Major Depressive Disorder, Panic Disorder, First Year, Patient Care, Curriculum and Pedagogy, Patient Simulation, Clinical Competence, Diagnostic Test, Bayes Theorem, Iowa, Predictive value of tests, Clinical clerkship, and internship and residency
Family physicians frequently err when applying Current Procedural Terminology (CPT) evaluation and management (E&M) codes to their office visits, but there are few published prospective studies on educational interventions to improve... more
Family physicians frequently err when applying Current Procedural Terminology (CPT) evaluation and management (E&M) codes to their office visits, but there are few published prospective studies on educational interventions to improve coding. Over a 6-year intervention period, 429 resident patient notes from return clinic visits were recoded by a faculty member with coding expertise. Feedback on coding accuracy and annual educational coding workshops were provided to the residents. Coding accuracy was calculated by subtracting residents' code from that of the faculty. Coding accuracy was analyzed cross-sectionally using all available data and longitudinally for 14 residents with data from all 3 years of the residency. Analysis of codings by 68 residents found that residents undercoded their clinic visits by 0.49 levels of service. Higher training year of the resident was associated with more accurate coding. Improvement over time was also found with the longitudinal analysis. How...
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Noninvasive, 24-hour ambulatory blood pressure monitoring (ABPM) has evolved over the past 25 years from a novel research tool of limited clinical use into an important and useful modality for stratifying cardiovascular risk and guiding... more
Noninvasive, 24-hour ambulatory blood pressure monitoring (ABPM) has evolved over the past 25 years from a novel research tool of limited clinical use into an important and useful modality for stratifying cardiovascular risk and guiding therapeutic decisions. Early clinical uses of ABPM were mostly focused on identifying patients with white-coat hypertension; however, accumulated evidence now points to greater prognostic significance in determining risk for hypertensive end-organ damage compared with office blood pressure measurements. Ambulatory measurement of blood pressure using automated devices has also demonstrated benefit in other indications, such as treatment resistance and borderline hypertension, and is recommended by the Joint National Committee for the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in a number of clinical scenarios. Medicare recently announced plans to begin reimbursement for ABPM, which will likely increase demand for ABPM serv...
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BACKGROUND Informal ("curbside") consults are widely used by primary care physicians. These interactions occur in person, by telephone, or even by e-mail. Exposure to malpractice liability is a frequent concern of subspecialty... more
BACKGROUND Informal ("curbside") consults are widely used by primary care physicians. These interactions occur in person, by telephone, or even by e-mail. Exposure to malpractice liability is a frequent concern of subspecialty physicians and influences their willingness to engage in this activity. To assess this risk, we reviewed reported judicial opinions involving informal consultation by physicians. METHODS A search of the existing medical literature, and of the Westlaw national database was undertaken to identify reported judicial opinions involving informal physician consults that address whether informal consultations create a legal relationship between consulting specialist physicians and patients that gives rise to a legal duty of care owed by the consulting specialist to the patient. CONCLUSIONS Courts have consistently ruled that no physician-patient relationship exists between a consultant and the patient who is the focus of the informal consultation. In the abs...
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Background and Objectives: In 2014, family medicine residency programs began to integrate point-of-care ultrasound (POCUS) into training, although very few had an established POCUS curriculum. This study aimed to evaluate the resources,... more
Background and Objectives: In 2014, family medicine residency programs began to integrate point-of-care ultrasound (POCUS) into training, although very few had an established POCUS curriculum. This study aimed to evaluate the resources, barriers, and scope of POCUS training in family medicine residencies 5 years after its inception. Methods: Questions regarding current training and use of POCUS were included in the 2019 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency program directors, and results compared to similar questions on the 2014 CERA survey. Results: POCUS is becoming a core component of family medicine training programs, with 53% of program directors reporting establishing or an established core curriculum. Only 11% of program directors have no current plans to add POCUS training to their program, compared to 41% in 2014. Despite this increase in training, the reported clinical use of POCUS remains uncommon. Onl...
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OBJECTIVE We investigated whether family medicine residents demonstrated increased skill in formulating clinical questions over their 3 years of training. METHODS We conducted an analysis of 454 questions asked by 49 family physician... more
OBJECTIVE We investigated whether family medicine residents demonstrated increased skill in formulating clinical questions over their 3 years of training. METHODS We conducted an analysis of 454 questions asked by 49 family physician residents engaged in informal consultation with subspecialists using an e-mail-based system. Clinical question formulation was measured on a scale of 0 to 2 by awarding 1 point each for the presence of a proposed intervention and a desired outcome. Changes in question formulation as residents progressed in their training were assessed using cross-sectional and repeated measures. FINDINGS The mean question quality was scored at 1.10, and there was no significant change over the 3 years. Thirteen residents used the e-mail service over their entire 3-year training period. The individual residents showed substantial differences in how well they formulated clinical questions, with their mean question quality scores ranging from 0.38 to 1.45. There was, howev...
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The use of incentive compensation in academic family medicine has been a topic of interest for many years, yet little is known about the impact of these systems on individual faculty members. Better understanding is needed about the... more
The use of incentive compensation in academic family medicine has been a topic of interest for many years, yet little is known about the impact of these systems on individual faculty members. Better understanding is needed about the relationship of incentive compensation systems (ICSs) to ICS satisfaction, motivation, and retention among academic family medicine faculty. The Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) conducted a nationwide survey of its members in 2013. This study reports the results of the incentive compensation question subset of the larger omnibus survey. The overall response rate was 53%. The majority (70% [360/511]) of academic faculty reported that they are eligible for some type of incentive compensation. The faculty reported moderate satisfaction, with only 38% being satisfied or highly satisfied with their ICS. Overall mean motivation and intent to remain in their current position were similar. The percentage of total in...
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People with chronic behavioural and physical health conditions have higher healthcare costs and mortality rates than patients with chronic physical conditions alone. As a result, there has been promotion of integrated care for this group.... more
People with chronic behavioural and physical health conditions have higher healthcare costs and mortality rates than patients with chronic physical conditions alone. As a result, there has been promotion of integrated care for this group. It is important to train primary care residents to practice in integrated models of care with interprofessional teams and to evaluate the effectiveness of integrated care models to promote high-quality care for this at-risk group. We implemented an integrated, interprofessional care management programme for adults with chronic mental and physical health needs as part of a curriculum for family medicine and family medicine psychiatry residents. We then evaluated the clinical effectiveness of this programme by describing participants' healthcare utilisation patterns pre- and post-enrolment. Patients enrolled in the programme were approximately 60-70% less likely to utilise the emergency room and 50% less likely to be admitted to the hospital after enrolment in the programme compared to before enrolment. The odds of individual attendance at outpatient primary care and mental health visits improved after enrolment. In the context of the implementation of integrated behavioural and physical healthcare in primary care, this interprofessional care management programme reduced emergency department utilisation and hospitalisations while improving utilisation of primary care and psychiatry outpatient care. Further studies should focus on replication of this model to further discern the model's cost-savings and health promotion effects.
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Research Interests: Humans, Hypertension, Blood Pressure, Circadian Rhythm, Clinical Medicine, and 15 moreFemale, Male, Clinical Sciences, Ambulatory, Aged, Middle Aged, Adult, Sensitivity and Specificity, Iowa, Predictive value of tests, Short Term, Ambulatory Blood Pressure, Systolic blood pressure, Arterial pressure, and Antihypertensive agents
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Radiology is an integral part of the office practice of many family physicians. Nevertheless, data are sparse on the performance of family physicians in this endeavor. This study investigated the performance of family physicians at... more
Radiology is an integral part of the office practice of many family physicians. Nevertheless, data are sparse on the performance of family physicians in this endeavor. This study investigated the performance of family physicians at interpreting radiographs ordered in a free-standing family practice office. A consecutive series of radiographic studies performed at a family practice office during a 3-year period was surveyed. All radiographic studies included in this analysis (N = 1674) were separately interpreted by the family physician ordering the study and an overreading radiologist. If the interpretations agreed, the studies were accepted as having been correctly interpreted. Cases in which the interpretations disagreed were reexamined. Family physicians correctly interpreted 92.4% of the radiographic studies (95% confidence interval, 91.0 to 93.6). Their accuracy with extremity films (96.0%) was significantly higher than their accuracy with chest films (89.3%, P < .001). Family physicians were more likely to correctly interpret normal films (95.2%) than abnormal ones (85.9%, P < .001). Thirty-five percent of the cases in which there were differences between family physician and radiologist interpretations were correctly interpreted by family physicians. Family physicians showed a high degree of accuracy in radiologic interpretation in an office setting. Chest films were inherently more difficult to interpret than extremity films. Because correct interpretation depends on body part examined and the prevalence of disease, the performance of family physicians will probably vary in different practice settings.
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Family physicians frequently err when applying Current Procedural Terminology (CPT) evaluation and management (E&M) codes to their office visits, but there are few published prospective... more
Family physicians frequently err when applying Current Procedural Terminology (CPT) evaluation and management (E&M) codes to their office visits, but there are few published prospective studies on educational interventions to improve coding. Over a 6-year intervention period, 429 resident patient notes from return clinic visits were recoded by a faculty member with coding expertise. Feedback on coding accuracy and annual educational coding workshops were provided to the residents. Coding accuracy was calculated by subtracting residents' code from that of the faculty. Coding accuracy was analyzed cross-sectionally using all available data and longitudinally for 14 residents with data from all 3 years of the residency. Analysis of codings by 68 residents found that residents undercoded their clinic visits by 0.49 levels of service. Higher training year of the resident was associated with more accurate coding. Improvement over time was also found with the longitudinal analysis. However, comparison of 23 residents' coding from before the first feedback and didactic session to codings after starting feedback suggests that these improvements were not due to the intervention. Residents improved in coding accuracy over time, but our educational intervention may not have been responsible for the improvement.
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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The prevalence of COPD among cigarette smokers in the Middle East is not well studied. A prospective descriptive study was performed in... more
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The prevalence of COPD among cigarette smokers in the Middle East is not well studied. A prospective descriptive study was performed in the north of Jordan. Male cigarette smokers (≥10 pack-year) aged 35 years and older were recruited from the community. They completed a questionnaire and a postbronchodilator spirometry. Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria (postbronchodilator forced expiratory volume in 1 second <70%) was used to define COPD. A total of 512 subjects completed the study protocol. According to the GOLD criteria, 42 subjects (8.2%) had COPD. Of those, 27 subjects (64.3%) had symptomatic COPD. Using the GOLD criteria, eight subjects (19%) with COPD had mild disease, 24 (57.1%) had moderate disease, eight (19%) had severe disease, and two (4.8%) had very severe disease. Only 10.6% were aware of COPD as a smoking-related respiratory i...
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Research Interests: Decision Making, Risk, Library and Information Studies, Humans, Female, and 13 moreMale, Patient Preference, Colonoscopy, Immunochemistry, Aged, Middle Aged, Public health systems and services research, Feces, Iowa, Colorectal Neoplasms, Surveys and Questionnaires, Early detection of cancer, and mass Screening
To examine the use of antibiotics by infants in eastern Iowa, longitudinal data were collected from a cohort recruited at birth from 8 hospitals. Parents of recruited children were mailed questionnaires 6 weeks, 3 months, and 6 months... more
To examine the use of antibiotics by infants in eastern Iowa, longitudinal data were collected from a cohort recruited at birth from 8 hospitals. Parents of recruited children were mailed questionnaires 6 weeks, 3 months, and 6 months after birth. Cumulative rates of use were determined by means of life tables for any antibiotic as well as by type of antibiotic. Factors associated with antibiotic use and patterns of use were also determined. There were data for 789 children. Antibiotic use was common in our cohort and increased with age. At 50, 100, 150, and 200 days of life, 8.7%, 26.7%, 37.3%, and 70.5%, respectively, of the infants had used at least 1 antibiotic. Infants were most frequently treated with amoxicillin, followed by cephalosporins and sulfonamides. Otitis media was the illness that most commonly prompted the use of an antibiotic.