Journal of general internal medicine
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Comparative Study
Evaluation of internists' spirometric interpretations.
Correct interpretation of screening spirometry results is essential in making accurate clinical diagnoses and directing subsequent pulmonary evaluation. The general internist is largely responsible for interpreting screening spirometric tests at community hospitals. However, reports of new guidelines for screening spirometry are infrequently published in the general internal medicine literature. This can lead to incorrect interpretations. We sought to evaluate whether spirometric interpretations by a group of practicing general internists differed from those of two board-certified pulmonologists using guidelines published by the American Thoracic Society (ATS). ⋯ The spirometric interpretations of a group of general internists differed significantly from those of two board-certified pulmonologists using published guidelines in approximately one third of cases. This may be because subspecialty guidelines are infrequently published in the general internal medicine literature. We believe that wider dissemination of these interpretative guidelines and ongoing physician education would improve general internists' ability to identify patients who require further pulmonary evaluation.
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Randomized Controlled Trial Clinical Trial
Effects of a physician communication intervention on patient care outcomes.
To determine whether an intervention designed to improve patient-physician communication increases the frequency with which physicians elicit patients' concerns, changes other communication behaviors, and improves health care outcomes. ⋯ A low-intensity intervention changed physician behavior but had no effect on patient outcomes such as satisfaction, compliance, or utilization. Interventions may need to focus on physicians and patients to have the greatest effect.
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To predict intravenous heparin dose requirements of patients treated for thromboembolic disorders. ⋯ The infusion dose of intravenous heparin effective for an individual patient can be predicted accurately from the patient's body weight and APTT response to the initial 6 hours of treatment. Especially in hospitals where validated heparin dosing nomograms are not used, clinicians may find this simple technique useful in achieving timely therapeutic anticoagulation.
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The homeless are more likely than other poor and vulnerable populations to manifest serious health problems. Early research focused on needs assessments of this population; current work has shifted to examine issues of access, use of health services, and barriers to care. However, current research has not examined whether model clinics designed for the homeless have created parity with their low-income domiciled peers in terms of provision of ambulatory services. Such data are increasingly in demand as managed care looms just over the political horizon as a means of providing services to low-income patients. ⋯ Findings from this study on the provision of care in a major West Los Angeles community health center indicate that homeless patients receiving care from a model program designed to address their special needs will return for follow-up visits and will utilize services at least as much as low-income domiciled patients.