Journal of general internal medicine
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Comparative Study
Self-reported halitosis and gastro-esophageal reflux disease in the general population.
Patients with halitosis contact primary care practitioners, dentists, and gastroenterologists alike. ⋯ The present study provides clear evidence for an association between GERD and halitosis. As there are effective treatments for GERD, these results suggest treatment options, such as proton pump inhibitors, for halitosis. These should be studied in randomized controlled trials.
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Ensuring access to high-quality cancer-related information is important for the success of cancer prevention and control efforts. ⋯ While a significant proportion of the American public searches for cancer information, suboptimal experiences are common. Facilitation of information seeking will be critical for promoting informed decision making in cancer prevention and control.
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Comparative Study
Voices of African American, Caucasian, and Hispanic surrogates on the burdens of end-of-life decision making.
End-of-life decisions are frequently made by patients' surrogates. Race and ethnicity may affect such decision making. Few studies have described how different racial/ethnic groups experience end-of-life surrogate decision making. ⋯ Regardless of race/ethnicity, surrogates for seriously ill patients appeared to experience increased significant, multidimensional burdens of decision making under conditions of uncertainty about a patient's preferences. This aspect of the burden of surrogate decision making may not be fully appreciated by physicians. Physicians should identify and be especially attentive to strategies used by surrogates, which may vary by race/ethnicity, to reduce the uncertainty about a patient's preferences and thus the burden of surrogate decision making to assist them in this difficult process.
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Increasing physician case volumes are documented to reduce costs and improve outcomes for many surgical procedures but not for medical conditions such as pneumonia that consume significant health care resources. ⋯ Data support an inverse volume-cost relationship for pneumonia care. Decision processes and clinical care of high-volume physicians versus low-volume physicians should be studied to develop effective care algorithms to improve pneumonia outcomes and reduce costs.
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There are few data available about factors which influence physicians' decisions to discharge patients from their practices. To study general internists' and family medicine physicians' attitudes and experiences in discharging patients from their practices. ⋯ Most physicians in our sample were willing to discharge actual and hypothetical patients from their practices. This tendency may have significant implications for the initiation of pay-for-performance programs. Physicians should be educated about the importance of the patient-physician relationship and their fiduciary obligations to the patient.