No abstract

Attention to the health and wellness of postgraduate medical trainees has increased considerably in recent years, yet the scholarly literature consistently indicates that, in many instances, the medical and mental health care needs of this population remain unmet or only partially met. As a result, trainee health care often falls short of the current standards of the medical profession. Combined with the prevalence of burnout and other mental health conditions among trainees, inadequate health care for this patient population may result in significant negative consequences for trainees' health, safety, and performance.Here, the authors review the scholarly literature explicating the health care needs of postgraduate trainees. They explore the patient-centered medical home model as a potentially effective solution to address the unmet and partially met health care needs of trainees. The authors describe several practical interventions to improve access to care. These include care coordination and referral support, confidential care without perceived conflicts of interest in the training environment, co-location of medical and mental health care, and accommodations for schedule constraints. Finally, the authors explore the role of the medical home in developing and supporting broader institutional efforts to promote wellness.

Abstracts S92documented via medical record or telephone communication. Exclusion criteria included: no follow-up, chronic pancreatitis, pancreatic pseudocyst, mass rather than cyst on EUS, and normal EUS exam. Th e remaining 767 patients were categorized by cyst type based upon clinical diagnosis. If pancreatic duct was ≥ 5 mm, cysts were categorized as either main-duct-IPMN (no associated cyst) or mixed-type IPMN (one or more pancreatic cysts present). Otherwise, cysts were categorized as mucinous cystic neoplasm (3-cm or larger unilocular or septated cyst in the pancreatic body/tail in females ≥ 40 years in age), serous cystadenoma (unilocular cyst with honeycomb appearance) or branched duct-IPMN (unilocular or mutlicystic). Pancreatic cancer diagnosis was made by FNA cytology, surgical specimen or imaging showing pancreatic mass with metastases. Death was determined by review of the medical record, contacting family members or by online resources. Results: Fift y-eight percent were female with average age of 67 years. 69% were asymptomatic. Average follow-up was 4 years. BD-IPMN was the most common cyst type comprising 78% of all EUS examinations, followed by mixed type-IPMN (9%) and SCN (7%). MD-IPMN and MCN were the least common accounting for 2% and 4% of all cysts, respectively. Seventy-four patients were diagnosed with pancreatic cancer. Th ough nearly one half of cancers were diagnosed in patients with BD-IPMN this corresponded to an overall low risk (6%). Mixed type-IPMN had the highest risk of cancer development at 38% with a 62% survival-free-of-cancer at 5 years. Conclusion: Th is large, multicenter study of patients referred for EUS of pancreas cysts shows that BD-IPMN is the most common type of pancreatic cyst, however those with Mixed type IPMN suff er the highest risk of cancer development. Purpose:To determine the prevalence of various disease processes accounting for the common complaint of gas and bloating in the outpatient setting. Methods: Electronic billing and medical records in an outpatient gastroenterology clinic from 2010-2012 were utilized. Patient visits with a presenting complaint coded as 787.3, "fl atulence, eructation and gas pain, " were reviewed by three independent physicians. Patients under the age of 18 were excluded, as were patients with an existing diagnosis other than IBS. Only patients who underwent some form of evaluation (i.e., laboratory, biopsy, motility study, or breath testing) were included. Final diagnoses were divided into eight categories: Fructose Intolerance (FI), Lactose Intolerance (LI), Small Intestinal Bacterial Overgrowth (SIBO), Celiac Disease (CD), functional disorders, motility disorders, other and unknown. Diagnoses were not considered mutually exclusive, and presumptive diagnoses (i.e., improved with lifestyle changes alone) were counted as unknown in the absence of objective data. Summary statistics were applied using SPSS soft ware. Results: Two hundred thirty-seven patients were included in the study population. 23.6% were male and 76.4% female....