Journal of general internal medicine
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To determine whether delirium can be diagnosed by telephone, we interviewed 41 subjects aged 65 years or older 1 month after repair of hip fracture, first by telephone and then face-to-face. Interviews included the modified telephone Mini-Mental State Examination and the Delirium Symptom Interview. ⋯ Of 35 patients not delirious by face-to-face assessment, 33 patients were not delirious by telephone (specificity = 0.94). We conclude that telephone interviews can effectively rule out delirium, but the positive diagnosis should be confirmed by a face-to-face assessment, especially in populations with a low prevalence of delirium.
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To identify from the literature and clinical experience a rational approach to management of fibroadenomas of the breast. ⋯ Age-based algorithms that allow for conservative management and that limit excision to patients whose fibroadenomas fail to regress are presented.
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To document the outcomes of a telephone coverage system and identify patient characteristics that may predict these outcomes. ⋯ In the present study, younger patients, female patients, and patients in commercial managed care plans used the telephone most frequently. Also, the telephone provided a viable alternative to emergency department and walk-in visits. Overall satisfaction with telephone medicine was high, and the strongest predictors of high patient satisfaction were symptom relief and patients' own health perception.
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To explore the attitudes and experiences of abused women to identify characteristics that helped or hindered abuse disclosure to clinicians and to determine how women viewed potential interventions to improve detection and treatment in a medical setting. ⋯ Many abused women experience worsening health and seek medical care; most do not volunteer a history of violence even to their regular clinicians. Many of the barriers to disclosure of abuse could be overcome by a physician's knowledge of the link between abuse and medical illness, an understanding of the women's emotions about abuse, and her treatment preferences.
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To describe the clinical features of adults diagnosed with acute bronchitis, and to identify clinical variables associated with antibiotic treatment of acute bronchitis. ⋯ Acute bronchitis is frequently treated with antibiotics in ambulatory practice. The clinical factors we identified to be associated with antibiotic use for acute bronchitis appear to play a minor role in explaining the excessive use of antibiotics for this condition. These findings suggest that clinicians use the diagnosis of acute bronchitis as an indication for antibiotic treatment, despite clinical trials and expert recommendations to the contrary.