Journal of general internal medicine
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To determine how the physical health of homeless adults varies by the demographic characteristics of age, gender, ethnicity, lifetime length of homelessness, and work status. ⋯ Age and gender contributed most to the understanding of differences in health status among homeless adults. Since the homeless have a wide variety of physical, mental, social, and substance-abuse problems, primary care providers are in the best position to provide the broad-based care needed by such persons.
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To assess the utilization of diagnostic and therapeutic medical services for the management of acute low back pain in a primary care setting, and to determine whether such utilization conforms to suggested guidelines for the management of this condition. ⋯ According to guidelines from the medical literature, the primary care physicians in this study both overutilized and underutilized diagnostic and referral services in cases of acute low back pain. It is necessary to determine whether underutilization of plain lumbar radiography adversely affects diagnostic accuracy and whether overutilization of other services improves important clinical outcomes, given the generally benign natural history of this condition.
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To examine the decision-making process to withhold or stop life support. ⋯ Decision making to withhold or withdraw life-support therapy from critically ill persons involves complex, difficult processes. Successful management of the tension among life extension, quality of life, patient autonomy, and social justice requires better understanding of these processes.
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To describe how physicians think and feel about their perceived mistakes, to examine how physicians' prior beliefs and manners of coping with mistakes may influence their emotional responses, and to promote further discussion in the medical community about this sensitive issue. ⋯ The perception of having made a mistake creates significant emotional distress for practicing physicians. The severity of this distress may be influenced by factors such as prior beliefs and perfectionism. The extent to which physicians share this distress with colleagues may be influenced by the degree of competitiveness engendered by medical training. Open discussion of mistakes should be more prominent in medical training and practice, and there should be continued research on this topic.
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Multicenter Study Clinical Trial
Physician electrocardiogram reading in the emergency department--accuracy and effect on triage decisions: findings from a multicenter study.
To determine how well physicians in emergency departments read electrocardiographic (ECG) ST-segment and T-wave changes and how this affects triage decisions. ⋯ Physicians in emergency departments often misread the ST segments and T waves of patients with possible acute cardiac ischemia. Misreading is related to suboptimal triage and unnecessary CCU admission. Training emergency physicians to make these distinctions more accurately could improve medical care and hospital utilization.