Journal of general internal medicine
-
Meta Analysis
Postponement of Death by Statin Use: a Systematic Review and Meta-analysis of Randomized Clinical Trials.
The average postponement of the outcome (gain in time to event) has been proposed as a measure to convey the effect of preventive medications. Among its advantages over number needed to treat and relative risk reduction is a better intuitive understanding among lay persons. ⋯ The systematic review was registered in PROSPERO [CRD42016037507] .
-
Multicenter Study Pragmatic Clinical Trial
Proactive Population Health Strategy to Offer Tobacco Dependence Treatment to Smokers in a Primary Care Practice Network.
Population-based strategies can expand the reach of tobacco cessation treatment beyond clinical encounters. ⋯ Smokers responding to a population-based, proactive outreach strategy had better provision of tobacco cessation treatment when referred to either a health system-based or community-based program compared with usual care. The health system-based strategy outperformed the quitline-based one in several measures. Future work should aim to improve population reach and test the effect on smoking cessation rates.
-
Urinary incontinence (UI) is a common malady in women. Numerous nonsurgical treatments are available, each associated with risk of adverse events (AEs). ⋯ Behavioral therapies and neuromodulation have low risk of AEs. Anticholinergics and alpha agonists have high rates of dry mouth and constitutional effects. BTX is associated with UTIs and voiding dysfunction. Periurethral bulking agents are associated with erosion and voiding dysfunction. These AEs should be considered when selecting appropriate UI treatment options. AE reporting is inconsistent and AE rates across studies tended to vary widely. Trials should report AEs more consistently.
-
Clinical reasoning is a core component of clinical competency that is used in all patient encounters from simple to complex presentations. It involves synthesis of myriad clinical and investigative data, to generate and prioritize an appropriate differential diagnosis and inform safe and targeted management plans. The literature is rich with proposed methods to teach this critical skill to trainees of all levels. ⋯ In this perspective, we first introduce the concepts of illness scripts and dual-process theory that describe the roles of analytic system 1 and non-analytic system 2 reasoning in clinical decision making. Thereafter, we draw upon existing evidence and expert opinion to review a range of methods that allow for effective assessment of clinical reasoning, contextualized within Miller's pyramid of learner assessment. Key assessment strategies that allow teachers to evaluate their learners' clinical reasoning ability are described from the level of knowledge acquisition, through to real-world demonstration in the clinical workplace.