The American journal of the medical sciences
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More than 100 million U.S. adults experience chronic nonmalignant pain. Many physicians are uncomfortable managing such patients. We sought to determine the timing and intensity of training that primary care physicians receive in chronic pain treatment, and the effect of training on their comfort in managing patients. ⋯ Most primary care physicians are not comfortable treating patients with chronic nonmalignant pain. Education increases primary care physicians' comfort in managing these patients. Increased comfort was associated with the willingness of primary care physicians to take charge of managing chronic pain. In addition, physician comfort is greatest when pain management skills are taught after residency training.
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Few studies use objective structured clinical examinations (OSCEs) to measure physical examination skills of internal medicine residents. Little is known about performance by year of residency training. ⋯ Senior residents performed better and were more confident on physical examination skills, but the difference disappeared after 1 month of internship. This calls into question how much further learning occurs with physical examination throughout residency training.
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Warfarin has been shown to decrease the rate of thromboembolic events in patients with nonvalvular atrial fibrillation, but it is frequently underprescribed. Our goal was to establish whether there have been racial disparities in the filling of warfarin prescriptions for patients with newly incident nonvalvular atrial fibrillation. ⋯ African-American patients in the Ohio Medicaid population between 1998 and 2002 were significantly less likely than white patients to fill a warfarin prescription for newly incident nonvalvular atrial fibrillation.