Journal of general internal medicine
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To explore potential item bias in the CAGE questions (mnemonic for cut-down, annoyed, guilty, and eye-opener) when used to screen for alcohol use disorders in primary care patients. ⋯ Despite its many advantages, the CAGE questionnaire is an inconsistent indicator of alcohol use disorders when used with male and female primary care patients of varying racial and ethnic backgrounds. Gender and cultural differences in the consequences of drinking and perceptions of problem alcohol use may explain these effects. These biases suggest the CAGE is a poor "rule-out" screening test. Brief and unbiased screens for alcohol use disorders in primary care patients are needed.
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The objective of this project was to compare faculty productivity in teaching and nonteaching clinical settings. We hypothesized that teaching activity would have no impact on productivity. A mixed model, repeated measures analysis of variance was used to analyze average relative value units (RVUs) billed and to test for differences between clinics. ⋯ Resident supervision increased faculty productivity, while student supervision had no impact on billed RVUs. Thus, RVUs can be used as a measure of faculty clinical productivity in different settings in an academic medical center. Precepting students does not appear to affect clinical productivity.
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Editorial Comment
Insights and limitations from health-related quality-of-life research.
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Comparative Study
Differences in generalist and specialist physicians' knowledge and use of angiotensin-converting enzyme inhibitors for congestive heart failure.
To quantify the extent and determinants of underutilization of angiotensin-converting enzyme (ACE) inhibitors for patients with congestive heart failure, especially with respect to physician specialty and clinical indication. ⋯ Compared with cardiologists, family practitioners and general internists probably underutilize ACE inhibitors, particularly among patients with decreased ejection fraction who are either asymptomatic or post-myocardial infarction. Educational efforts should focus on these indications and emphasise the dosages demonstrated to lower mortality and morbidity in the trials.
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To summarise current knowledge of interventions that should improve the care of patients with type II diabetes mellitus. Interventions lie within the realms of preventions, screening, and treatment, all of which are focused on office practice. ⋯ An algorithm-based guideline for screening and treatment of the complications of diabetes was developed. The emphasis is on prevention of atherosclerotic disease, and prevention, screening, and early treatment of microvascular disease. Implementation of these practices has the potential to significantly improve quality of life and increase life expectancy in patients with type II diabetes mellitus.