Catherine Dubé

Thorough skin examination for the early detection of melanoma

BACKGROUNDnMelanoma is a major public health problem for which early detection may reduce mortality. Since melanoma is generally asymptomatic, this requires skin examination. We sought to evaluate the extent to which the general public has their skin examined by themselves, their partners, or health care providers and the frequency of these examinations.nnnMETHODSnRandom-digit-dial survey of adult Rhode Islanders.nnnRESULTSnOnly 9% performed a thorough skin examination (TSE) at least once every few months, although over half of the sample reported conducting skin self-examination deliberately and systematically. Participants were more likely to perform TSE if they were women and if their health care provider had asked them to examine their skin. Most participants reported that their health care provider never or rarely looked at the areas of their skin in which melanoma is most likely to arise.nnnCONCLUSIONSnThe reported frequency of skin self-examination depends critically on the manner of inquiry. TSE by self or a partner is uncommon, and health care providers do not routinely examine the areas of the skin on which melanomas commonly arise.

Good samaritan kidney donation

Because close genetic matching between the donor and recipient is no longer required to achieve a highly successful outcome, there is currently widespread acceptance of a kidney transplant from a live donor who is genetically unrelated, but emotionally connected to the recipient. This concept has recently been taken a step further to include kidney donation from strangers—individuals who are not genetically or emotionally tied to the recipient. The volunteer stranger donor may express a desire to donate to any person on the transplant waiting list, termed nondirected live-kidney donation. Alternatively, the volunteer may become aware of a specific individual with end-stage renal disease (ESRD), but have no connection or previous relationship with the patient, termed directed stranger donation. The term “good samaritan” may be applied to either case, because the volunteer helps a stranger in a profoundly charitable way. Herein, we describe the development and growth of a Good Samaritan Kidney Donor program at a single institution. A general acceptance of good samaritan donation at our center, favorable publicity, and a geographically defined population base all contributed to the success of this program.

Beyond the basics: refills by electronic prescribing.

INTRODUCTIONnE-prescribing is part of a new generation of electronic solutions for the medical industry that may have great potential for improving work flow and communication between medical practices and pharmacies. In the US, it has been introduced with minimal monitoring of errors and general usability. This paper examines refill functionality in e-prescribing software.nnnMETHODSnA mixed method study including focus groups and surveys was conducted. Qualitative data were collected in on-site focus groups or individual interviews with clinicians and medical office staff at 64 physician office practices. Focus group participants described their experiences with the refill functionality of e-prescribing software, provided suggestions for improving it, and suggested improvements in office procedures and software functionality.nnnRESULTSnOverall, approximately 50% reduction in time spent each day on refills was reported. Overall reports of refill functionality were positive; but clinicians and staff identified numerous difficulties and glitches associated managing prescription refills. These glitches diminished over time. Benefits included time saved as well as patient convenience. Potential for refilling without thought because of the ease of use was noted. Clinicians and staff appreciated the ability to track whether patients are filling and refilling prescriptions.nnnDISCUSSIONnE-prescribing software for managing medication refills has not yet reached its full potential. To reduce work flow barriers and medication errors, software companies need to develop error reporting systems and response teams to deal effectively with problems experienced by users. Examining usability issues on both the medical office and pharmacy ends is required to identify the behavioral and cultural changes that accompany technological innovation and ease the transition to full use of e-prescribing software.

Internal Medicine Residency Training for Unhealthy Alcohol and Other Drug Use: Recommendations for Curriculum Design

BackgroundUnhealthy substance use is the spectrum from use that risks harm, to use associated with problems, to the diagnosable conditions of substance abuse and dependence, often referred to as substance abuse disorders. Despite the prevalence and impact of unhealthy substance use, medical education in this area remains lacking, not providing physicians with the necessary expertise to effectively address one of the most common and costly health conditions. Medical educators have begun to address the need for physician training in unhealthy substance use, and formal curricula have been developed and evaluated, though broad integration into busy residency curricula remains a challenge.DiscussionWe review the development of unhealthy substance use related competencies, and describe a curriculum in unhealthy substance use that integrates these competencies into internal medicine resident physician training. We outline strategies to facilitate adoption of such curricula by the residency programs. This paper provides an outline for the actual implementation of the curriculum within the structure of a training program, with examples using common teaching venues. We describe and link the content to the core competencies mandated by the Accreditation Council for Graduate Medical Education, the formal accrediting body for residency training programs in the United States. Specific topics are recommended, with suggestions on how to integrate such teaching into existing internal medicine residency training program curricula.SummaryGiven the burden of disease and effective interventions available that can be delivered by internal medicine physicians, teaching about unhealthy substance use must be incorporated into internal medicine residency training, and can be done within existing teaching venues.