Mount Sinai Journal of Medicine最新文献_第5页

Primary care training and the evolving healthcare system. 初级保健培训和不断发展的卫生保健系统。

Mount Sinai Journal of Medicine Pub Date : 2012-07-01 DOI: 10.1002/msj.21329

Lauren A Peccoralo, Kathryn Callahan, Rachel Stark, Linda V DeCherrie

{"title":"Primary care training and the evolving healthcare system.","authors":"Lauren A Peccoralo, Kathryn Callahan, Rachel Stark, Linda V DeCherrie","doi":"10.1002/msj.21329","DOIUrl":"https://doi.org/10.1002/msj.21329","url":null,"abstract":"With growing numbers of patient-centered medical homes and accountable care organizations, and the potential implementation of the Patient Protection and Affordable Care Act, the provision of primary care in the United States is expanding and changing. Therefore, there is an urgent need to create more primary-care physicians and to train physicians to practice in this environment. In this article, we review the impact that the changing US healthcare system has on trainees, strategies to recruit and retain medical students and residents into primary-care internal medicine, and the preparation of trainees to work in the changing healthcare system. Recruitment methods for medical students include early preclinical exposure to patients in the primary-care setting, enhanced longitudinal patient experiences in clinical clerkships, and primary-care tracks. Recruitment methods for residents include enhanced ambulatory-care training and primary-care programs. Financial-incentive programs such as loan forgiveness may encourage trainees to enter primary care. Retaining residents in primary-care careers may be encouraged via focused postgraduate fellowships or continuing medical education to prepare primary-care physicians as both teachers and practitioners in the changing environment. Finally, to prepare primary-care trainees to effectively and efficiently practice within the changing system, educators should consider shifting ambulatory training to community-based practices, encouraging resident participation in team-based care, providing interprofessional educational experiences, and involving trainees in quality-improvement initiatives. Medical educators in primary care must think innovatively and collaboratively to effectively recruit and train the future generation of primary-care physicians.","PeriodicalId":51137,"journal":{"name":"Mount Sinai Journal of Medicine","volume":"79 4","pages":"451-63"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/msj.21329","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30755809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 12

The patient-centered medical home: history, components, and review of the evidence. 以病人为中心的医疗之家:历史、组成部分和证据回顾。

Mount Sinai Journal of Medicine Pub Date : 2012-07-01 DOI: 10.1002/msj.21326

Jonathan Arend, Jenny Tsang-Quinn, Claudia Levine, David Thomas

{"title":"The patient-centered medical home: history, components, and review of the evidence.","authors":"Jonathan Arend, Jenny Tsang-Quinn, Claudia Levine, David Thomas","doi":"10.1002/msj.21326","DOIUrl":"https://doi.org/10.1002/msj.21326","url":null,"abstract":"The US healthcare system is plagued by unsustainable costs and yields suboptimal outcomes, indicating that new models of healthcare delivery are needed. The patient-centered medical home is one model that is increasingly regarded as a promising strategy for improving healthcare quality, decreasing cost, and enhancing the experience of both patients and providers. Conceptually, the patient-centered medical home may be described as combination of the core attributes of primary care-access, continuity, comprehensiveness, and coordination of care-with new approaches to healthcare delivery, including office practice innovations and reimbursement reform. Implementation efforts are gaining momentum across the country, fueled by both private-payer initiatives as well as supportive public policy. High-quality evidence on the effectiveness of the patient-centered medical home is limited, but the data suggest that, under some circumstances, patient-centered medical home interventions may lead to improved outcomes and generate moderate cost savings. Although the patient-centered medical home enjoys broad support by multiple stakeholders, significant challenges to widespread adoption of the model remain.","PeriodicalId":51137,"journal":{"name":"Mount Sinai Journal of Medicine","volume":"79 4","pages":"433-50"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/msj.21326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30755808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 122

Cognitive and behavioral treatment options for insomnia. 失眠的认知和行为治疗方案。

Mount Sinai Journal of Medicine Pub Date : 2012-07-01 DOI: 10.1002/msj.21320

Matthew R Ebben, Mariya Narizhnaya

引用次数: 7

Role of institutional climate in fostering diversity in biomedical research workforce: a case study. 制度氛围在促进生物医学研究人员多样性方面的作用:一个案例研究。

Mount Sinai Journal of Medicine Pub Date : 2012-07-01 DOI: 10.1002/msj.21323

Gary C Butts, Yasmin Hurd, Ann-Gel S Palermo, Denise Delbrune, Suman Saran, Chati Zony, Terry A Krulwich

{"title":"Role of institutional climate in fostering diversity in biomedical research workforce: a case study.","authors":"Gary C Butts, Yasmin Hurd, Ann-Gel S Palermo, Denise Delbrune, Suman Saran, Chati Zony, Terry A Krulwich","doi":"10.1002/msj.21323","DOIUrl":"10.1002/msj.21323","url":null,"abstract":"This article reviews the barriers to diversity in biomedical research and describes the evolution of efforts to address climate issues to enhance the ability to attract, retain, and develop underrepresented minorities, whose underrepresentation is found both in science and medicine, in the graduate-school biomedical research doctoral programs (PhD and MD/PhD) at Mount Sinai School of Medicine. We also describe the potential beneficial impact of having a climate that supports diversity and inclusion in the biomedical research workforce. The Mount Sinai School of Medicine diversity-climate efforts are discussed as part of a comprehensive plan to increase diversity in all institutional programs: PhD, MD/PhD, and MD, and at the residency, postdoctoral fellow, and faculty levels. Lessons learned from 4 decades of targeted programs and activities at the Mount Sinai School of Medicine may be of value to other institutions interested in improving diversity in the biomedical science and academic medicine workforce.","PeriodicalId":51137,"journal":{"name":"Mount Sinai Journal of Medicine","volume":"79 4","pages":"498-511"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/msj.21323","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30755712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 21

Patient registries in primary care: essential element for quality improvement. 初级保健病人登记:提高质量的基本要素。

Mount Sinai Journal of Medicine Pub Date : 2012-07-01 DOI: 10.1002/msj.21328

Elizabeth I Molina-Ortiz, Aida C Vega, Neil S Calman

引用次数: 12

Global health and primary care: increasing burden of chronic diseases and need for integrated training. 全球卫生和初级保健:慢性病负担日益加重和综合培训的需要。

Mount Sinai Journal of Medicine Pub Date : 2012-07-01 DOI: 10.1002/msj.21327

Joseph Truglio, Michelle Graziano, Rajesh Vedanthan, Sigrid Hahn, Carlos Rios, Brett Hendel-Paterson, Jonathan Ripp

{"title":"Global health and primary care: increasing burden of chronic diseases and need for integrated training.","authors":"Joseph Truglio, Michelle Graziano, Rajesh Vedanthan, Sigrid Hahn, Carlos Rios, Brett Hendel-Paterson, Jonathan Ripp","doi":"10.1002/msj.21327","DOIUrl":"https://doi.org/10.1002/msj.21327","url":null,"abstract":"Noncommunicable diseases, including cardiovascular disease, chronic respiratory disease, diabetes, cancer, and mental illness, are the leading causes of death and disability worldwide. These diseases are chronic and often mediated predominantly by social determinants of health. Currently there exists a global-health workforce crisis and a subsequent disparity in the distribution of providers able to manage chronic noncommunicable diseases. Clinical competency in global health and primary care could provide practitioners with the knowledge and skills needed to address the global rise of noncommunicable diseases through an emphasis on these social determinants. The past decade has seen substantial growth in the number and quality of US global-health and primary-care training programs, in both undergraduate and graduate medical education. Despite their overlapping competencies, these 2 complementary fields are most often presented as distinct disciplines. Furthermore, many global-health training programs suffer from a lack of a formalized curriculum. At present, there are only a few examples of well-integrated US global-health and primary-care training programs. We call for universal acceptance of global health as a core component of medical education and greater integration of global-health and primary-care training programs in order to improve the quality of each and increase a global workforce prepared to manage noncommunicable diseases and their social mediators.","PeriodicalId":51137,"journal":{"name":"Mount Sinai Journal of Medicine","volume":"79 4","pages":"464-74"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/msj.21327","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30755810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 27

Primary care: healthcare's leading edge. 初级保健:医疗保健的前沿。

Mount Sinai Journal of Medicine Pub Date : 2012-07-01 DOI: 10.1002/msj.21325

Aida Vega, David C Thomas

{"title":"Primary care: healthcare's leading edge.","authors":"Aida Vega, David C Thomas","doi":"10.1002/msj.21325","DOIUrl":"https://doi.org/10.1002/msj.21325","url":null,"abstract":"There is widespread agreement by many professional societies, consumer groups, public policy advisers, and health plans that primary-care providers will be major drivers behind changes in healthcare delivery. Primary-care providers comprise mostly general internists, pediatricians, family physicians, and nonphysician providers. Studies suggest that primary-care providers have lower levels of use of diagnostic tests and procedures, resulting in equal to lower costs of care as compared with specialists.1 In addition, primary-care providers have been linked to improved quality of care. Patients who have longterm clinical relationships with a provider are more likely to receive preventive care.1 Patients who have a ‘‘usual source of care’’ are more likely to be satisfied with their healthcare and have fewer emergency room visits. Continuity of care has also been associated with lower rates of hospital admissions and lower costs.1 In this issue of the Mount Sinai Journal of Medicine, we provide a review of the current state of primary care and future directions. Primary-care systems redesign, such as the patient-centered medical home (PCMH) and the chronic care model, as described by Arend et al. in this issue, offers promise for delivering patientcentered care and improving patient satisfaction, access to care, care coordination, and health outcomes through team-based care and population management. The article also discusses options for reimbursement reform, which will be a key factor in","PeriodicalId":51137,"journal":{"name":"Mount Sinai Journal of Medicine","volume":"79 4","pages":"423-4"},"PeriodicalIF":0.0,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/msj.21325","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30755806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Home-based primary care: a needed primary-care model for vulnerable populations. 基于家庭的初级保健:弱势群体所需的初级保健模式。

Mount Sinai Journal of Medicine Pub Date : 2012-07-01 DOI: 10.1002/msj.21321

Linda V DeCherrie, Theresa Soriano, Jennifer Hayashi

引用次数: 36

Organ transplantation update, part II: heart and kidney. 器官移植更新，第二部分:心脏和肾脏。

Mount Sinai Journal of Medicine Pub Date : 2012-05-01 DOI: 10.1002/msj.21319

Sander Florman, Leona Kim-Schluger

{"title":"Organ transplantation update, part II: heart and kidney.","authors":"Sander Florman, Leona Kim-Schluger","doi":"10.1002/msj.21319","DOIUrl":"https://doi.org/10.1002/msj.21319","url":null,"abstract":"On December 23, 1954, Dr. Joseph Murray performed the first successful long-term human kidney transplant using a kidney from the patient’s twin brother in Boston. The success of this transplant initiated an exciting time in clinical transplantation and sparked efforts in virtually all other organs. Nearly 13 years later on December 3, 1967, on another continent, Dr. Christiaan Barnard performed the first successful human heart transplant in Cape Town, South Africa. During this same time period successful liver, pancreas, and lung transplants were also performed. The articles in the first special transplant edition of the Mount Sinai Journal of Medicine (Volume 79, Issue 2, March/April 2012) were reflective of the success and controversies in liver, intestine, and pancreas transplantation. The articles in this second special transplant edition focus on kidney and heart transplantation as well as donation and transplant immunology. During this developmental period in transplantation, surgical and medical techniques were refined with improved preservation techniques and the addition of antithymocyte globulin to the immunosuppressant regimen of prednisone and azathioprine. Despite the early success in the 1960s and early 1970s, the morbidity and mortality after transplant remained high due to the technical complexities and the lack of drugs to adequately counteract rejection of the transplanted organ. The 4 decades since these pioneering efforts have realized tremendous advancements in the field of liver transplantation, with thousands of","PeriodicalId":51137,"journal":{"name":"Mount Sinai Journal of Medicine","volume":"79 3","pages":"303-4"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/msj.21319","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30675552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Indications for heart transplantation in current era of left ventricular assist devices. 当前左心室辅助装置时代心脏移植的适应症。

Mount Sinai Journal of Medicine Pub Date : 2012-05-01 DOI: 10.1002/msj.21313

Federico Milla, Sean P Pinney, Anelechi C Anyanwu

引用次数: 6