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Dreyer Medical Clinic Ad, 2002
No full textDreyer Medical Clinic, Aurora, IL: Advertisement from 2002 featuring 12 clinic locationshttps://institutionalrepository.aah.org/alldocuments/2110/thumbnail.jp
FDA-regulated clinical trials vs. real-world data: How to bridge the gap in pain research
No full textRandomized controlled trials (RCTs) have been regarded as the gold standard for evaluating the efficacy of treatments for chronic pain and are the foundation for regulatory approval and guideline development. However, their restrictive design and dependence on idealized populations can limit their applicability to the diverse patients seen in routine chronic pain management. Real-world data (RWD), collected from electronic medical records, registries, claims databases, and digital health platforms, can offer a more comprehensive view of treatment adherence and safety that RCTs often overlook. A key issue in pain medicine is the efficacy–effectiveness gap, where discrepancies exist between the outcomes of therapies and interventions in RCTs versus in real-world practice due to variations in patient populations and adherence. Bridging this gap ensures that observed improvements align with patients’ preferred outcomes and functional goals. Integrating the strengths of RCTs and RWD provides a more comprehensive evidence base to guide clinical decision-making, influence reimbursement policies, and develop equitable guidelines. The primary aim of this paper is to identify factors used in FDA-regulated RCTs and RWD that could be implemented or enhanced in everyday practice to deliver more holistic and patient-centered care in the management of chronic pain
Contraceptive knowledge and counseling among OB-GYN and family medicine physicians
No full textIntroduction: Few studies have examined contraceptive knowledge and counseling confidence among primary care residents and physicians. Authors of this study evaluated education, knowledge, and counseling practices related to contraception among physicians in obstetrics and gynecology (OB-GYN) and family medicine (FM).
Methods: In this prospective, cross-sectional study, current OB-GYN and FM residents, as well as program graduates from the past five years at a single institution, were surveyed. The survey assessed demographics, contraception knowledge, provider confidence, counseling practices, and procedural experience. Responses were included in the analysis if at least one knowledge question was completed.
Results: The final analysis included 45 respondents (8% response rate): 33.3% (n = 15) from FM and 66.7% (n = 30) from OB-GYN. Average knowledge scores did not differ significantly between FM (60%, 12/20) and OB-GYN physicians (70%, 14/20). Attending physicians\u27 average scores were significantly higher (85%, 17/20) than residents (60%, 12/20; p = 0.0014). Most respondents (97.8%, n = 44) reported feeling comfortable counseling patients, and 93.3% (n = 42) felt comfortable performing procedures and prescribing contraceptives. OB-GYN physicians reported greater comfort placing levonorgestrel and Paragard® intrauterine devices (IUDs) than FM physicians (93%, n = 14 vs. 61%, n = 11; p = 0.040). More OB-GYN physicians (6.7%, n = 3) reported performing over 80 Nexplanon® insertions compared to FM physicians (0.0%, n = 0; p \u3c0.0001).
Conclusions: Contraceptive knowledge did not differ significantly between OB-GYN and FM physicians. However, advanced training was associated with greater comfort in both prescribing and performing contraceptive procedures
Sepsis and the heart: In the quest for noninvasive pressure-volume loops at the bedside
No full textBackground: Sepsis-induced cardiomyopathy (SICM) is prevalent yet remains difficult to diagnose using conventional echocardiography primarily due to its dependence on loading conditions, the dynamic nature of sepsis, and varied cardiovascular phenotypes. Recent advancements in noninvasive myocardial work (MW) analysis, particularly through left ventricle pressure-strain loop (LV PSL), offer a promising strategy for evaluating myocardial function by combining strain imaging with blood pressure data. This technique may address the limitations inherent in traditional measures such as ejection fraction, which can be influenced by fluctuating hemodynamics in sepsis and may not accurately reflect underlying myocardial function.
Case summary: This report presents three cases wherein patients exhibited either preserved or only mildly reduced left ventricular systolic function based on ejection fraction (LVEF), but were found to have diminished MW indices, including global work index, global constructive work, and global work efficiency along with low flow by left ventricle outflow-tract.
Conclusions: Relying solely on LVEF for diagnosing SICM is problematic due to numerous confounding variables. MW parameters constitute innovative, noninvasive echocardiographic indicators that have demonstrated value across a spectrum of cardiac disorders. Although these parameters appear promising as bedside assessment tools, their application within the context of sepsis warrants further investigation
