Let low-risk moms eat during labor?

Review of: Ciardulli A, Saccone G, Anastasio H, et al. Less-restrictive food intake during labor in low-risk singleton pregnancies: a systematic review and meta-analysis. Obstet Gynecol. 2017;129:473-480.Let low-risk moms eat during labor? Allowing low-risk pregnant women to eat less restrictive diets during labor may not only make them happier, but may shorten labor, too. Practice changer: Allowing low-risk patients planning for a vaginal delivery less restrictive diets during labor does not seem to increase the risk of aspiration or other harms and may shorten labor. Stength of recommendation: A: Based on a meta-analysis of 10 randomized controlled trials (RCTs) in tertiary hospitals.Karen Phelps, MD; Justin Deavers, MD; Dean A. Seehusen, MD, MPH; James J. Stevermer, MD, MSPH ; Eisenhower Army Medical Center, Fort Gordon, Ga (Drs. Phelps, Deavers, and Seehusen); Department of Family and Community Medicine, University of Missouri-Columbia (Dr. Stevermer)

Bread and Butter of Family Medicine: Guidelines, Population Screening, Diagnostic Evaluations, and Practice Models

This issue of JABFM is full of evidence and thoughtful articles on topics central to family medicine. These articles critically examine what family physicians do on a daily basis. Reports in this issue provide new evidence regarding guidelines, screening programs, evaluation procedures, and practice models. Clinical articles report that the sensitivity of mailed Fecal Immunochemical Testing changes with the weather; a dermatoscope and a simple algorithm can help differentiate malignant from benign skin lesions; and that a few almonds can alter blood glucose levels in response to a glucose tolerance test. Readers will find an excellent discussion about whether, and how, the growing number of clinical guidelines should be overseen going forward. We also have a first-hand account of the Inaugural Starfield Summit, a meeting of family medicine leaders working to improve primary care for all. These topics, and plenty of additional new evidence pertinent to the daily practice of family physicians can be found in this issue.

Research in Family Medicine by Family Physicians for the Practice of Family Medicine

This issue lays out challenges for family medicine researchers. Each article increases our understanding of solutions to common problems in family medicine, yet with each, one can readily see the next challenge based on the newly gained knowledge. One of the goals of the JABFM is to encourage research in family medicine for family medicine. Here we combine our usual editors\u27 notes with thoughts about what the next research studies could, and hopefully will, be

This Issue: Important Clinical Studies with New Useful Information on Problems Encountered Daily by Family Physicians

Oh, what an issue! Extra, Extra, Read all about it! Patients deceiving doctors for prescriptions; characteristics of chronic pain seekers in primary care versus specialty settings; potential overuse of antidepressants when depression screening instruments are used; improving smoking quit rates through anger/stress management training; using immunoglobulin G levels to diagnose and follow eradication of Helicobacter pylori; patient- and family-friendly gentle cesarean deliveries; plus the economic impact of family physicians delivering babies … quite a line-up this issue. We also provide information on using motivational interviewing techniques for treating depression, correlations between specific chronic illnesses and the receipt of preventive services, and family physicians\u27 knowledge of tests considered overused

Improving Family Medicine with Thoughtful Research

This issue is about improving primary health care outcomes, from behavioral health to opioid issues to diagnosing hypertension to providing hope for childhood obesity. It includes hints for integrating behavioral health and care managers into family medicine practices. Opiate prescribing practices vary considerably between Japan and the United States, with helpful insights for our opiate abuse epidemic. Suicidality is high among patients taking opiates. Diagnosing hypertension the recommended way is not easily accomplished. Primary care clinicians are important in infertility and prostate cancer treatment, and in support of men who commit interpersonal violence and people with cognitive impairment who wander. The “July effect” seems to persist. Parents\u27 views on obesity in children can be changed—for the better. Family physicians have less burnout than has been previously reported, and many provide palliative care. Doctors think diseases, patients think about how well they feel. Do we find healthy lifestyles in retirement

In This Issue: Opiates, Tobacco, Social Determinants of Health, Social Accountability for Non-Profit Hospitals, More on PCMH, and Clinical Topics

This issue contains several articles about the factors contributing to the complex and deadly interplay between social determinants of health, pain, mental illness, and addictive substances such as opioids and tobacco. One article clearly is a call to action: more than half of opioid prescriptions in the United States are given to patients with mental health problems. Two articles report work on the next steps for social determinants of health in health care settings. Social accountability based on community health needs assessments required of community hospitals should lead to the creation of more family medicine residency positions. Patient-centered medical home (PCMH) recognition can be costly. A new typology for PCMHs is proposed. Other topics include group advance care planning visits, the interaction of dental and primary care, free clinics, a fix for a squeaking wrist, adherence to latent tuberculosis treatment, and more

Real-Life Observational Studies Provide Actionable Data for Family Medicine

This issue includes several excellent observational studies prompted by physicians\u27 clinical questions. Many people use lots of menthol cough drops—does the menthol overall lengthen the cough duration? When should we intensify treatment of older individuals with diabetes? Do occipital nerve blocks work for acute migraine headaches? Did you know that the plantar fascia can rupture? What happens to those patients with chest pain but low pretest probability for serious cardiac disease who are admitted to the hospital? Acupuncture can work well—for the patients—but how can we incorporate it into the usual pace of the family medicine office? Is it a win-lose situation when medical assistant roles are expanded? How many practice sites do physicians have and does that make a difference in the number or type of health personnel shortage areas? What would you guess on the presence of humor in the medical office—more or less than half of the visits; introduced by doctors or patients; primary care or specialty doctors

Multiple Practical Facts and Ideas to Improve Family Medicine Care

Seconds count in a study on the best electronic health note format to reduce medical record charting time and increase accuracy. Directly observed family physician work is compared with Current Procedural Terminology (CPT) coding examples and notably under-recognized. This issue contains articles from single practices that that implemented new methods of care and other reports on practice innovations that can be more broadly implemented. We have articles on opioid medication use for acute low back pain in primary care, an electronic chronic pain consult service, a key question to identify potential opioid misuse risk, and newly implemented screening for other substances of abuse. Omissions (or gaps) in care are also highlighted: from the common types of omissions identified by primary care clinicians, self-reported low levels of substance use screening by family medicine prenatal care providers, and inadequate and inadequately available hospital discharge summaries. In addition, the most important alarm symptoms for a cancer diagnosis are reported

Interventions Must Be Realistic to Be Useful and Completed in Family Medicine

Being realistic while helping our patients is this issue\u27s theme. Given the volume of tasks required in family medicine, recommendations for improvements in direct care or care measurement cannot just be evidence-based but must also be realistic. On the list of realistic: ordering antipsychotics for symptoms of dementia in the elderly, despite recommendations to not do so; ordering antidepressants without fear that the patient could develop hypertension; mental health care providers in primary care offices; forced choice for opioid management; plus agenda setting for visit efficiency. Not yet realistic: trigger tools to identify adverse events, and pharmacist recommendations related to pain management before opioid visits. Pneumococcal vaccine compliance is only realistic if recommendations are not recurrently changed, are paid for, and if prior immunizations are known. Increasing task delegation to prevent clinician burnout is not realistic if it burns out the nurses, or if the helpful scribes cannot be afforded. Helpful, yet questionably realistic: Primary care clinician involvement for patients in intensive care units and their families, and problem-solving therapy by family physicians. And, let us add ‘frightening’: few international medical school graduates to serve the underserved. The most frequent diagnoses and most critical diagnoses in family medicine are elucidated