Journal of general internal medicine
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Randomized Controlled Trial Comparative Study
Does prevalence matter to physicians in estimating post-test probability of disease? A randomized trial.
The probability of a disease following a diagnostic test depends on the sensitivity and specificity of the test, but also on the prevalence of the disease in the population of interest (or pre-test probability). How physicians use this information is not well known. ⋯ Most physicians do not take into account the prevalence of disease when interpreting a positive test result. This may cause unnecessary testing and diagnostic errors.
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Randomized Controlled Trial Comparative Study
The impact of resident duty hour reform on hospital readmission rates among Medicare beneficiaries.
A key goal of resident duty hour reform by the Accreditation Council for Graduate Medical Education (ACGME) in 2003 was to improve patient outcomes. ⋯ Among Medicare beneficiaries, there were no changes in hospital readmission rates associated with resident duty hour reform.
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Comparative Study
Primary care providers’ judgments of opioid analgesic misuse in a community-based cohort of HIV-infected indigent adults.
Primary care providers (PCPs) must balance treatment of chronic non-cancer pain with opioid analgesics with concerns about opioid misuse. ⋯ PCPs’ impressions of misuse were discordant with patients’ self-reports of opioid analgesic misuse. PCPs incorrectly used age and race as predictors of misuse in this high-risk cohort.
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Systematic reviews have the potential to inform clinical decisions, yet little is known about the impact of interventions on increasing the use of systematic reviews in clinical decision-making. ⋯ The limited empirical data render the strength of evidence weak for the effectiveness and types of interventions that encourage clinicians to use systematic reviews in clinical decision making.
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Among older adults with chronic kidney disease (CKD), the comparative event rates of end-stage renal disease (ESRD) and cause-specific death are unknown. ⋯ Older adults with CKD are 13-fold more likely to die from any cause than progress to ESRD and are 6-fold more likely to die from cardiovascular causes than develop ESRD.