Journal of general internal medicine
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Many women experience a breast lump. Clinical guidelines suggest that a normal mammogram result alone is not adequate to exclude a diagnosis of cancer. ⋯ Many women do not receive adequate evaluation for a recent breast lump. Interventions should be designed to improve the follow-up of women with this common clinical problem.
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Review
Interactions between pharmaceutical representatives and doctors in training. A thematic review.
Medical school and residency are formative years in establishing patterns of prescribing. We aimed to review the literature regarding the extent of pharmaceutical industry contact with trainees, attitudes about these interactions, and effects on trainee prescribing behavior, with an emphasis on points of potential intervention and policy formation. ⋯ The pharmaceutical industry has a significant presence during residency training, has gained the overall acceptance of trainees, and appears to influence prescribing behavior. Training programs can benefit from policies and curricula that teach residents about industry influence and ways in which to critically evaluate information that they are given. Recommendations for local and national approaches are discussed.
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Multicenter Study
Sins of omission: getting too little medical care may be the greatest threat to patient safety.
Little is known about the relative incidence of serious errors of omission versus errors of commission. ⋯ While preventing iatrogenic injury resulting from medical errors is a critically important part of quality improvement, we found that the overwhelming majority of substantive medical errors identifiable from the medical record were related to people getting too little medical care, especially for those with chronic medical conditions.
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Randomized Controlled Trial
A randomized-controlled study of encounter cards to improve oral case presentation skills of medical students.
To determine the feasibility of oral case presentation (OCP) encounter cards as a tool for formative evaluation, to estimate the reliability and validity of the ratings when used in a medicine clerkship, and to examine whether the use of OCP encounter cards improves students' OCP skills. ⋯ OCP encounter cards are a novel and feasible tool to assess clerkship students' oral case presentation skills. OCP card ratings are reproducible, and validity is suggested by their correlation with multiple markers of performance. However, encounter cards did not improve performance on summative oral presentations.
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Comparative Study
Self-reported comorbidities, perceived needs, and sources for usual care for older and younger homeless adults.
While older individuals who are homeless tend to be in poorer health, it is less clear how they view their health care needs and whether their self-reported patterns for accessing health services differ from younger homeless counterparts. ⋯ Older homeless adults have a greater disease burden than their younger counterparts. However, it is unclear whether these needs are being appropriately identified and met. There is a need for specific and targeted outreach to connect them to appropriate services.