Flexor digitorum profundus fractures are caused by forceful extension of the distal interphalangeal joint when in a flexed position, resulting in an avulsion fracture at the volar base of the distal phalanx, and usually require surgery. Uncomplicated middle and proximal phalanx fractures, typically caused by a direct blow, can be treated with buddy splinting if there is minimal angulation (less than 10 degrees); however, larger angulations, displacement, and malrotation often require reduction or surgery. Dorsal proximal interphalangeal joint dislocations require reduction and buddy splinting in slight flexion with an extension-block splint.
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The updated guideline, ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents, was developed by the American Academy of Pediatrics and endorsed by the American Academy of Family Physicians.
Access the article with full recommendation for more information on ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.
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Evidence Summary:
A 2000 systematic review assessed 32 studies[PS1] with more than 2,300 patients from 1966 to 1998 that measured patient satisfaction after video telehealth consultations with healthcare providers.1 The review included 1 RCT (N=104), 1 case control study (N=50), and 30 cross sectional studies with participant inclusion via random selection, referrals, convenience samples, volunteers, or unspecified techniques). Included studies ranged over varying healthcare provider settings from family medicine to a range of differing specialties. Studies were excluded if they used telecommunication technology for educational or administrative purposes not involving provision of care to patients. The primary outcome was overall participant satisfaction with telemedicine. There was no standardized outcome measure used; 26 studies used survey instruments, while 1 used qualitative analysis and 5 did not specify. Methodological heterogeneity therefore precluded formal statistical analysis and there were no numbers to report in this study. The authors conducted qualitative analysis of the data and findings with no standardized scoring method. The qualitative analysis revealed that video telemedicine was generally well-accepted in all studies; specific advantages were access to specialist care, less travel, and reduced wait times; disadvantages were video communication. Authors critically appraised each study using a checklist and found several conces related to validity and generalizability of individual studies. This study is limited by the subjective nature of qualitative analysis and unclear methodology of the analysis; the largest study in this review (N=585) was conducted in a prison setting, limiting generalizability of results to the general patient population.
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HDA Number: 87
Title: Patient Satisfaction with Video Telemedicine
Word Count: *
HDA Question: Is patient satisfaction with video telemedicine primary care visits comparable to face-to-face office visits?
Yes. Patients rate video telemedicine visits comparably to face-to-face visits for satisfaction and quality of care. (SOR: B, systematic review and cross-sectional studies) Time saved is an advantage; video communication and technical conces are disadvantages. (SOR: B, systematic review and cross-sectional study) Predictors of higher satisfaction with telemedicine include patient understanding of telehealth, female gender, and uninsured status. (SOR: B, cross-sectional study) Cross-sectional studies included patients agreeable to telehealth visits and may be subject to selection bias. More studies are needed in primary care.
[PS1]Can you give an example of how to quantify conclusions as you had suggested?
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After medical school, I trained in primary care. I wanted to become my patients’ “Go-To” doctor- someone they can talk to about anything and everything. Whether that is to seek a 2nd opinion or an advice in their family dynamic. Soon after during residency training I created a reputation for myself and a panel of patients who appreciated my approach. Patients were long treated differently and seeing a young enthusiastic face genuinely caring for them and leaing about their was noticeable to them.
While training in primary care, I got introduced to cosmetic/aesthetic medicine. It was clear to me from the beginning I could be treating someone’s diabetes or high blood pressure for years but the gratitude I am given by changing the same person’s appearance is much greater.
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This question always brings tears to my eyes - it makes me appreciate the jouey and take a step back from everyday hustle and momentum. I was just 17 years old when I decided to move to the United States from Iran - to pursue my American dream.
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