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The resulting diagnosis was confirmed by

toxin A found in his serum a few days after the patient died.

Progressive cranial nerve palsy with symmetric descending paralysis with heroin abuse should raise the suspicion of WB and require prompt diagnosis and treatment. This case highlights raising awareness of the disease could help lead to early diagnosis and treatment.

Progressive cranial nerve palsy with symmetric descending paralysis with heroin abuse should raise the suspicion of WB and require prompt diagnosis and treatment. This case highlights raising awareness of the disease could help lead to early diagnosis and treatment.

Lack of training among health care providers (HCPs) to safely prescribe opioids is a contributing factor to the opioid crisis. Training and other resources have been developed to educate providers about safe and appropriate opioid prescribing practices.

The national survey was conducted with 2000 HCPs representing primary care physicians (PCPs), including family practice, general practice, and internal medicine; specialists (SPs); physician assistants (PAs); and nurse practitioners (NPs), a mix of primary care and specialists. This survey examined exposure to opioid educational information and opioid prescribing.

PCPs reported prescribing opioids for chronic pain to significantly more patients compared with other HCP groups. PCPs (89.8%) and NPs (85.5%) reported significantly greater exposure to opioid educational information compared with both SPs (71.9%) and PAs (78.8%). Overall, HCPs had limited knowledge about abuse-deterrent formulations, but PCPs had greater knowledge than other groups. HCPs had an increased likelihood of prescribing opioids to fewer patients in the last 3 months relative to the prior 12 months if they worked in a state or county clinic vs a solo or group practice type (adjusted odds ratio [AOR] = 1.97; 95% confidence interval [CI], 1.12-3.49) and were exposed to more opioid educational information during the last 12 months (AOR = 1.19; 95% CI, 1.06-1.32).

HCPs' exposure to opioid educational information was associated with less opioid prescribing for chronic pain. Findings indicated a difference in exposure and knowledge gaps across provider groups. More information is needed on the content of opioid educational information provided to HCPs.

HCPs' exposure to opioid educational information was associated with less opioid prescribing for chronic pain. Findings indicated a difference in exposure and knowledge gaps across provider groups. More information is needed on the content of opioid educational information provided to HCPs.

During the Coronavirus disease 2019 (COVID-19) pandemic, wearing facemasks became obligatory worldwide.

The objective of this study was to evaluate the effects of facemasks on gas exchange.

Healthy adults were assessed at rest and during slow and brisk 5-minute walks, with and without masks. We monitored O

saturation, end-tidal carbon dioxide (EtCO

), and heart and respiratory rates. Participants graded their subjective difficulty and completed individual sensations questionnaires.

Twenty-one participants with a median age of 38 years (range, 29-57 years) were recruited. At rest, all vital signs remained normal, without and with masks. However, during slow and brisk walks, EtCO

increased; the rise was significantly higher while wearing masks slow walk, mean EtCO

(mmHg) change +4.5 ± 2.4 versus +2.9 ± 2.3,

= .004; brisk walk EtCO

change +8.4 ± 3.0 versus +6.2 ± 4.0,

= .009, with and without masks, respectively. Wearing masks was also associated with higher proportions of participant hypeand desaturation. The clinical significance of these minor gas exchange abnormalities is unclear and should be further investigated.

Practice-based research networks (PBRNs) have developed dynamically across the world, paralleling the emergence of the primary care discipline. While this review focuses on the internal environment of PBRNs, the complete framework will be presented incrementally in future publications.

We conducted a scoping review of the published and gray literature. Electronic databases, including MEDLINE (PubMed), OVID, CINAHL (EBSCOhost), Scopus, and SAGE Premier, were searched for publications between January 1, 1965 and December 31, 2020 for English-language articles. Rigorous inclusion/exclusion criteria were implemented to identify relevant publications, and inductive thematic analysis was applied to elucidate key elements, subthemes, and themes. Social network theory was used to synthesize findings.

A total of 229 publications described the establishment of 93 PBRNs in 15 countries that met the inclusion criteria. The overall framework yielded 3 main themes, 12 subthemes, and 57 key elements. Key PBRN activities included relationship building between academia and practitioners and development of a learning environment through multidirectional communication.

PBRNs across many countries contributed significantly to shaping the landscape of primary health care and became an integral part of it. Many common features within the sphere of PBRNs can be identified that seem to promote their establishment across the world.

PBRNs across many countries contributed significantly to shaping the landscape of primary health care and became an integral part of it. Many common features within the sphere of PBRNs can be identified that seem to promote their establishment across the world.

To compare rural independent and health system primary care practices with urban practices to external practice facilitation support in terms of recruitment, readiness, engagement, retention, and change in quality improvement (QI) capacity and quality metric performance.

The setting consisted of 135 small or medium-sized primary care practices participating in the Healthy Hearts Northwest quality improvement initiative. The practices were stratified by geography, rural or urban, and by ownership (independent [physician-owned] or system-owned [health/hospital system]). The quality improvement capacity assessment (QICA) survey tool was used to measure QI at baseline and after 12 months of practice facilitation. Changes in 3 clinical quality measures (CQMs)-appropriate aspirin use, blood pressure (BP) control, and tobacco use screening and cessation-were measured at baseline in 2015 and follow-up in 2017.

Rural practices were more likely to enroll in the study, with 1 out of 3.5 rural recruited practices enrolled, compared with 1 out of 7 urban practices enrolled. Rural independent practices had the lowest QI capacity at baseline, making the largest gain in establishing a regular QI process involving cross-functional teams. Rural independent practices made the greatest improvement in meeting the BP control CQM, from 55.5% to 66.1% (

≤ .001) and the smoking cessation metric, from 72.3% to 86.7% (

≤ .001).

Investing practice facilitation and sustained QI strategies in rural independent practices, where the need is high and resources are low, will yield benefits that outweigh centrally prescribed models.

Investing practice facilitation and sustained QI strategies in rural independent practices, where the need is high and resources are low, will yield benefits that outweigh centrally prescribed models.

Approximately 5% of the US adult population has Attention Deficient Hyperactivity Disorder (ADHD) that can negatively impact quality of life. Health care professionals report a need to increase their knowledge of and confidence in treating adult ADHD. The American Academy of Family Physicians National Research Network (AAFP NRN) collaborated with a panel of experts to create a web-based AAFP Adult ADHD Toolkit composed of resources to aid in the diagnosis, management, and treatment of adults with ADHD.

Assess the impact of using an AAFP Adult ADHD Toolkit in a practice setting.

Ninety-seven primary and behavioral health care professionals from AAFP NRN practices (n=6) used the Toolkit for 17 weeks. Data on Toolkit use, usefulness, implementation, impact, and changes in knowledge and confidence were collected via pre-post and weekly surveys. Mixed methods, regression analyses,

-tests, and mixed ANOVA were used to assess change over time.

Use of the Toolkit improved health care providers' knowledge byinto the routine care of adults with ADHD measurably increased health care professionals' knowledge especially in those providers who regularly see adult patients with ADHD.

This study aimed to determine the rates of psychiatric medication users in the United States between 1999 to 2018 for different medication categories by age and sex.

The 1999 to 2002, 2006 to 2009, and 2015 to 2018 Medical Expenditure Panel Surveys (MEPS) were used for the analysis. All individuals with a valid age were included. Any antidepressant, benzodiazepine, attention deficit hyperactivity disease (ADHD) medication, antipsychotics, and mood stabilizer report use was defined as a medication user. Separate multivariable logistic regression predicted medication users by age with restricted cubic splines by sex, medication category, and year category (1999 to 2002, 2006 to 2009, and 2015 to 2018). In addition, the rate of prescribing to males and females at different ages was determined for medication categories.

Rates of any psychiatric medication users increased during the study period. Females had higher rates of medication users around 20 years of age. Rates of antidepressant users increased overion categories.

Black men are disproportionately impacted by prostate cancer. Guidelines agree that Black men should make informed decisions about whether to engage in prostate cancer screening. YouTube is widely used among Black men and impacts understanding of health conditions.

Given that misleading online health information might be especially harmful to Black men, the objective of this study was to evaluate the quality of information regarding prostate cancer screening for Black men available on YouTube.

Four viewers watched the top 50 videos using the search term "Prostate Cancer Screening in Black Men." Videos were scored using the previously validated DISCERN quality criteria for consumer health information and the Patient Education Materials Assessment Tool (PEMAT). Results were compared based on video characteristics like presenter perceived demographics and viewer engagement metrics.

Inter-rater reliability testing showed consistency for the PEMAT (interclass correlation coefficient [ICC] = 0.69) and DISCERN (ICC= 0.85). Few videos (16%) met the DISCERN quality threshold (54.4/80), and 28% of videos met the PEMAT threshold (10.5/15). Less than half of videos addressed racial disparities in prostate cancer. There was no difference in quality based on perceived race of the presenter (DISCERN

= .06, PEMAT

= .43).

The overall quality of videos about prostate cancer screening in Black men is poor, including those with Black presenters. Clinicians should be aware of potential misinformation that Black patients receive from YouTube and the opportunity to improve the quality of available information about prostate cancer screening in Black men.

The overall quality of videos about prostate cancer screening in Black men is poor, including those with Black presenters. Clinicians should be aware of potential misinformation that Black patients receive from YouTube and the opportunity to improve the quality of available information about prostate cancer screening in Black men.