Lauren Hersh - Academia.edu (original) (raw)
Papers by Lauren Hersh
q History : 48-year-old male who is a retired-semi-professional football player. He has h/o mild... more q History : 48-year-old male who is a retired-semi-professional football player. He has h/o mild intermittent toe pain following several significant turf toe injuries over last 2 years playing football. Has never been evaluated. • 1 week prior to presentation, he developed acute left great toe pain while walking. He denies recent injury. Pain significantly worse than previously. He is unable to put his shoe on secondary to pain and walks with a limp. Pain/ swelling minimally improved despite Ibuprofen 800mg TID for 1 week. • Preliminary evaluation by physician revealed red and swollen left 1 st MTP. He was advised to take Ibuprofen and Tylenol 1 more week.
Telemedicine and e-Health
Journal of the American Geriatrics Society, 2020
I t is well established that a small percentage (5%) of patients with complex health and social n... more I t is well established that a small percentage (5%) of patients with complex health and social needs use a disproportionate share (50%) of medical care. High healthcare utilization for this subset of patients comes with substantial costs for these individuals, the healthcare system, and society at large. Paradoxically, the high costs incurred by this heterogeneous group do not correlate with high-quality care, satisfaction with care, or improved patient outcomes. In fact, the opposite is true. These “superutilizers” often lack access to high-quality care, are dissatisfied with their care, and have poorer health status and worse health outcomes. The juxtaposition of high cost against poor outcomes is attributed to a healthcare delivery system that drives cyclical utilization and spiraling costs while failing to meet the health and social needs of complex patients. Much work has been performed to discover, describe, and address the major shortcomings of a U.S. healthcare delivery sys...
Palpable breast masses, mastalgia, and nipple discharge are commonly encountered symptoms in outp... more Palpable breast masses, mastalgia, and nipple discharge are commonly encountered symptoms in outpatient practice, causing significant patient anxiety and precipitating medical consultation. The initial workup includes a detailed clinical history and physical examination. Women presenting with a breast mass will require imaging and further assessment to exclude cancer. Diagnostic mammography is usually preferred, but ultrasonography is more sensitive in women younger than 30 years. Any suspicious mass detected on physical examination, mammography, or ultrasonography should undergo biopsy. In most cases, a core needle biopsy should be performed with imaging guidance for evaluation of a suspicious mass. Mastalgia is usually not an indication of underlying malignancy. Oral contraceptives, hormone therapy, some psychotropic drugs, and some cardiovascular agents have been associated with mastalgia. Focal breast pain should be evaluated with diagnostic imaging. Targeted ultrasonography loc...
Health literacy includes a set of skills needed to make appropriate health decisions and successf... more Health literacy includes a set of skills needed to make appropriate health decisions and successfully navigate the health care system. These skills include reading, writing, numeracy, communication, and, increasingly, the use of electronic technology. National data indicate that more than one-third of U.S. adults have limited health literacy, which contributes to poor health outcomes and affects patient safety, and health care access and quality. Although there are a number of tools that screen for limited health literacy, they are primarily used for research. Routinely screening patients for health literacy has not been shown to improve outcomes and is not recommended. Instead, multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concret...
Clinical Aspects of Aging, 2000
American family physician, Jan 15, 2015
Health literacy includes a set of skills needed to make appropriate health decisions and successf... more Health literacy includes a set of skills needed to make appropriate health decisions and successfully navigate the health care system. These skills include reading, writing, numeracy, communication, and, increasingly, the use of electronic technology. National data indicate that more than one-third of U.S. adults have limited health literacy, which contributes to poor health outcomes and affects patient safety, and health care access and quality. Although there are a number of tools that screen for limited health literacy, they are primarily used for research. Routinely screening patients for health literacy has not been shown to improve outcomes and is not recommended. Instead, multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concret...
American family physician, Jan 15, 2015
Health literacy includes a set of skills needed to make appropriate health decisions and successf... more Health literacy includes a set of skills needed to make appropriate health decisions and successfully navigate the health care system. These skills include reading, writing, numeracy, communication, and, increasingly, the use of electronic technology. National data indicate that more than one-third of U.S. adults have limited health literacy, which contributes to poor health outcomes and affects patient safety, and health care access and quality. Although there are a number of tools that screen for limited health literacy, they are primarily used for research. Routinely screening patients for health literacy has not been shown to improve outcomes and is not recommended. Instead, multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concret...
The Journal of family practice, 2014
The risk assessment tools, medication reconciliation steps, and discharge script provided here ca... more The risk assessment tools, medication reconciliation steps, and discharge script provided here can help you keep your patients from going back into the hospital.
American family physician, 2013
Most cases of urinary incontinence in women fall under one of three major subtypes: urge, stress,... more Most cases of urinary incontinence in women fall under one of three major subtypes: urge, stress, or mixed. A stepped-care approach that advances from least invasive (behavioral modification) to more invasive (surgery) interventions is recommended. Bladder retraining and pelvic floor muscle exercises are first-line treatments for persons without cognitive impairment who present with urge incontinence. Neuromodulation devices, such as posterior tibial nerve stimulators, are an option for urge incontinence that does not respond to behavioral therapy. Pharmacologic therapy with anticholinergic medications is another option for treating urge incontinence if behavioral therapy is unsuccessful; however, because of adverse effects, these agents are not recommended in older adults. Other medication options for urge incontinence include mirabegron and onabotulinumtoxinA. Sacral nerve stimulators, which are surgically implanted, have also been shown to improve symptoms of urge incontinence. P...
q History : 48-year-old male who is a retired-semi-professional football player. He has h/o mild... more q History : 48-year-old male who is a retired-semi-professional football player. He has h/o mild intermittent toe pain following several significant turf toe injuries over last 2 years playing football. Has never been evaluated. • 1 week prior to presentation, he developed acute left great toe pain while walking. He denies recent injury. Pain significantly worse than previously. He is unable to put his shoe on secondary to pain and walks with a limp. Pain/ swelling minimally improved despite Ibuprofen 800mg TID for 1 week. • Preliminary evaluation by physician revealed red and swollen left 1 st MTP. He was advised to take Ibuprofen and Tylenol 1 more week.
Telemedicine and e-Health
Journal of the American Geriatrics Society, 2020
I t is well established that a small percentage (5%) of patients with complex health and social n... more I t is well established that a small percentage (5%) of patients with complex health and social needs use a disproportionate share (50%) of medical care. High healthcare utilization for this subset of patients comes with substantial costs for these individuals, the healthcare system, and society at large. Paradoxically, the high costs incurred by this heterogeneous group do not correlate with high-quality care, satisfaction with care, or improved patient outcomes. In fact, the opposite is true. These “superutilizers” often lack access to high-quality care, are dissatisfied with their care, and have poorer health status and worse health outcomes. The juxtaposition of high cost against poor outcomes is attributed to a healthcare delivery system that drives cyclical utilization and spiraling costs while failing to meet the health and social needs of complex patients. Much work has been performed to discover, describe, and address the major shortcomings of a U.S. healthcare delivery sys...
Palpable breast masses, mastalgia, and nipple discharge are commonly encountered symptoms in outp... more Palpable breast masses, mastalgia, and nipple discharge are commonly encountered symptoms in outpatient practice, causing significant patient anxiety and precipitating medical consultation. The initial workup includes a detailed clinical history and physical examination. Women presenting with a breast mass will require imaging and further assessment to exclude cancer. Diagnostic mammography is usually preferred, but ultrasonography is more sensitive in women younger than 30 years. Any suspicious mass detected on physical examination, mammography, or ultrasonography should undergo biopsy. In most cases, a core needle biopsy should be performed with imaging guidance for evaluation of a suspicious mass. Mastalgia is usually not an indication of underlying malignancy. Oral contraceptives, hormone therapy, some psychotropic drugs, and some cardiovascular agents have been associated with mastalgia. Focal breast pain should be evaluated with diagnostic imaging. Targeted ultrasonography loc...
Health literacy includes a set of skills needed to make appropriate health decisions and successf... more Health literacy includes a set of skills needed to make appropriate health decisions and successfully navigate the health care system. These skills include reading, writing, numeracy, communication, and, increasingly, the use of electronic technology. National data indicate that more than one-third of U.S. adults have limited health literacy, which contributes to poor health outcomes and affects patient safety, and health care access and quality. Although there are a number of tools that screen for limited health literacy, they are primarily used for research. Routinely screening patients for health literacy has not been shown to improve outcomes and is not recommended. Instead, multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concret...
Clinical Aspects of Aging, 2000
American family physician, Jan 15, 2015
Health literacy includes a set of skills needed to make appropriate health decisions and successf... more Health literacy includes a set of skills needed to make appropriate health decisions and successfully navigate the health care system. These skills include reading, writing, numeracy, communication, and, increasingly, the use of electronic technology. National data indicate that more than one-third of U.S. adults have limited health literacy, which contributes to poor health outcomes and affects patient safety, and health care access and quality. Although there are a number of tools that screen for limited health literacy, they are primarily used for research. Routinely screening patients for health literacy has not been shown to improve outcomes and is not recommended. Instead, multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concret...
American family physician, Jan 15, 2015
Health literacy includes a set of skills needed to make appropriate health decisions and successf... more Health literacy includes a set of skills needed to make appropriate health decisions and successfully navigate the health care system. These skills include reading, writing, numeracy, communication, and, increasingly, the use of electronic technology. National data indicate that more than one-third of U.S. adults have limited health literacy, which contributes to poor health outcomes and affects patient safety, and health care access and quality. Although there are a number of tools that screen for limited health literacy, they are primarily used for research. Routinely screening patients for health literacy has not been shown to improve outcomes and is not recommended. Instead, multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concret...
The Journal of family practice, 2014
The risk assessment tools, medication reconciliation steps, and discharge script provided here ca... more The risk assessment tools, medication reconciliation steps, and discharge script provided here can help you keep your patients from going back into the hospital.
American family physician, 2013
Most cases of urinary incontinence in women fall under one of three major subtypes: urge, stress,... more Most cases of urinary incontinence in women fall under one of three major subtypes: urge, stress, or mixed. A stepped-care approach that advances from least invasive (behavioral modification) to more invasive (surgery) interventions is recommended. Bladder retraining and pelvic floor muscle exercises are first-line treatments for persons without cognitive impairment who present with urge incontinence. Neuromodulation devices, such as posterior tibial nerve stimulators, are an option for urge incontinence that does not respond to behavioral therapy. Pharmacologic therapy with anticholinergic medications is another option for treating urge incontinence if behavioral therapy is unsuccessful; however, because of adverse effects, these agents are not recommended in older adults. Other medication options for urge incontinence include mirabegron and onabotulinumtoxinA. Sacral nerve stimulators, which are surgically implanted, have also been shown to improve symptoms of urge incontinence. P...