Journal of general internal medicine
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Randomized Controlled Trial Comparative Study
Sustained pain reduction through affective self-awareness in fibromyalgia: a randomized controlled trial.
Affect and how it is regulated plays a role in pain perception, maintenance of pain, and its resolution. This randomized, controlled trial evaluated an innovative affective self-awareness (ASA) intervention, which was designed to reduce pain and improve functioning in individuals with fibromyalgia. ⋯ The affective self-awareness intervention improved pain, tenderness, and self-reported physical function for at least 6 months in women with fibromyalgia compared to wait-list control. This study suggests the value of interventions targeting emotional processes in fibromyalgia, although further studies should evaluate the efficacy of this intervention relative to active controls.
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Randomized Controlled Trial Comparative Study
Potential unintended consequences due to Medicare's "no pay for errors" rule? A randomized controlled trial of an educational intervention with internal medicine residents.
Medicare has selected 10 hospital-acquired conditions for which it will not reimburse hospitals unless the condition was documented as "present on admission." This "no pay for errors" rule may have a profound effect on the clinical practice of physicians. ⋯ Survey administered from December 2008 to March 2009. There were 119 responses (71%). In four of five vignettes, the intervention group was less likely to select the most clinically appropriate response. This was statistically significant in two of the cases. Most residents were aware of the rule but not its impact and specifics. Residents acknowledged responsibility to know Medicare documentation rules but felt poorly trained to do so. Residents educated about the Medicare's "no pay for errors" were less likely to select the most clinically appropriate responses to clinical vignettes. Such choices, if implemented in practice, have the potential for causing patient harm through unnecessary tests, procedures, and other interventions.
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Randomized Controlled Trial Comparative Study
Where have all the general internists gone?
A shortage of primary care physicians is expected, due in part to decreasing numbers of physicians entering general internal medicine (GIM). Practicing general internists may contribute to the shortage by leaving internal medicine (IM) for other careers in and out of medicine. ⋯ About one in six general internists leave IM by mid-career compared to one in 25 IM subspecialists. Although research finds that doctors leave medicine because of dissatisfaction, this study was inconclusive about whether general internists left IM in greater proportion than IM subspecialists for this reason. A more likely explanation is that GIM serves as a stepping stone to careers outside of IM.
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Randomized Controlled Trial
Predictors of adherence to nicotine gum and counseling among African-American light smokers.
A high proportion of African-American smokers are light smokers, and they experience low smoking cessation rates and disproportionately high tobacco-related morbidity; yet no studies have examined tobacco treatment adherence in this group. ⋯ Individual risk factors may influence adherence to nicotine gum and counseling. Improving psychological interventions and promoting adherence to counseling may increase overall smoking cessation success among African-American light smokers.
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Randomized Controlled Trial Comparative Study
A randomized community-based intervention trial comparing faith community nurse referrals to telephone-assisted physician appointments for health fair participants with elevated blood pressure.
To measure the effect of faith community nurse referrals versus telephone-assisted physician appointments on blood pressure control among persons with elevated blood pressure at health fairs. ⋯ Church health fairs conducted in low-income, multiethnic communities can identify many people with elevated blood pressure. Facilitating physician appointments for people with elevated blood pressure identified at health fairs confers a greater decrease in SBP than referral to a faith community nurse at four months.