Journal of general internal medicine
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Randomized Controlled Trial
Promoting use of colorectal cancer screening tests. Can we change physician behavior?
Colorectal cancer (CRC) screening is underutilized despite evidence that screening reduces mortality. ⋯ With the exception of an increase in rates of SIG in the intervention group, the intervention had no effect on rates of CRC screening. Future interventions should assess innovative approaches to increase rates of CRC screening.
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The majority of health care, both for acute and chronic conditions, is delivered in the ambulatory setting. Despite repeated proposals for change, the majority of internal medicine residency training still occurs in the inpatient setting. Substantial changes in ambulatory education are needed to correct the current imbalance. To assist educators and policy makers in this process, this paper reviews the literature on ambulatory education and makes recommendations for change. ⋯ This updated review continues to identify key deficiencies in ambulatory training curriculum and faculty skills. The authors make several recommendations: (1) Make training in the ambulatory setting a priority. (2) Address systems problems in practice environments. (3) Create learning experiences appropriate to the resident's level of development. (4) Teach and evaluate in the examination room. (5) Expand subspecialty-based training to the ambulatory setting. (6) Make faculty development a priority. (7) Create and fund multiinstitutional educational research consortia.
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Comparative Study
Physicians' initial management of acute low back pain versus evidence-based guidelines. Influence of sciatica.
Little information is available on physician characteristics and patient presentations that may influence compliance with evidence-based guidelines for acute low back pain. ⋯ A majority of primary care physicians continue to be noncompliant with evidence-based back pain guidelines. Sciatica dramatically influenced clinical decision-making, increasing the extent of noncompliance, particularly for internal medicine and family practice. Physicians' misunderstanding of sciatica's natural history and belief that more intensive initial management is indicated may be factors underlying the observed influence of sciatica.
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Comparative Study
Chlamydia screening and management practices of primary care physicians and nurse practitioners in California.
Because sexually transmitted chlamydial infections are common among young women, it is critical that providers screen and manage these infections appropriately. ⋯ The Chlamydia care practices of many California primary care providers are inconsistent with current guidelines. Targeted provider education and improved reimbursements are potential strategies for improvement.