Journal of general internal medicine
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Comparative Study
Use of a geriatric home visit experience to teach medical students the functional status assessment.
Functional status measures strongly predict hospital outcomes and mortality, yet teaching of these measures is often missing from medical schools' curricula. To address this deficiency, we developed a Geriatric Home-based Assessment (GHA) module for third-year medical students. The module was composed of a workshop and two to three home visits. ⋯ Our GHA module was effective in improving students' knowledge and proficiency in the functional status assessment. "Hands on" experiences like the GHA allow students to develop a solid foundation for assessing functional status and mobility.
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Meta Analysis Comparative Study
Gabapentin versus tricyclic antidepressants for diabetic neuropathy and post-herpetic neuralgia: discrepancies between direct and indirect meta-analyses of randomized controlled trials.
Previous systematic reviews concluded that tricyclics antidepressants are superior to gabapentin for neuropathic pain, but were based on indirect comparisons from placebo-controlled trials. ⋯ Though direct evidence is limited, we found no difference in likelihood of achieving pain relief between gabapentin and tricyclic antidepressants for diabetic neuropathy and post-herpetic neuralgia. Indirect analyses that combine data from sets of trials conducted in different eras can be unreliable.
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Randomized Controlled Trial Comparative Study
A culturally tailored navigator program for colorectal cancer screening in a community health center: a randomized, controlled trial.
Minority racial/ethnic groups have low colorectal cancer (CRC) screening rates. ⋯ A culturally tailored, language-concordant navigator program designed to identify and overcome barriers to colorectal cancer screening can significantly improve colonoscopy rates for low income, ethnically and linguistically diverse patients. ClinicalTrials.gov registration number: NCT00476970.
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Comparative Study
Getting by: underuse of interpreters by resident physicians.
Language barriers complicate physician-patient communication and adversely affect healthcare quality. Research suggests that physicians underuse interpreters despite evidence of benefits and even when services are readily available. The reasons underlying the underuse of interpreters are poorly understood. ⋯ Although previous research has identified time constraints and lack of availability of interpreters as reasons for their underuse, our data suggest that the reasons are far more complex. Residents at the study institutions with interpreters readily available found it easier to "get by" without an interpreter, despite misgivings about negative implications for quality of care. Findings suggest that increasing interpreter use will require interventions targeted at both individual physicians and the practice environment.
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Comparative Study
Effectiveness of the 5-As tobacco cessation treatments in nine HMOs.
Smoking remains the leading cause of preventable mortality in the US. The national clinical guideline recommends an intervention for tobacco use known as the 5-As (Ask, Advise, Assess, Assist, and Arrange). Little is known about the model's effectiveness outside the research setting. ⋯ Smokers were more likely to report quitting if they were offered cessation medications or if they used either medications or counseling. Results are similar to findings from clinical trials and highlight the need for clinicians and health plans to provide more than just advice to quit.