Journal of general internal medicine
-
Universal pain screening with a 0-10 pain intensity numeric rating scale (NRS) has been widely implemented in primary care. ⋯ The most commonly used measure for pain screening may have only modest accuracy for identifying patients with clinically important pain in primary care. Further research is needed to evaluate whether pain screening improves patient outcomes in primary care.
-
Colorectal cancer screening rates remain low, especially among low-income and racial/ethnic minority groups. ⋯ The intervention appears to be a feasible means to improve colorectal cancer screening rates among patients served by community health centers. However, more attention to patient decision making and education may be needed to further increase screening rates.
-
Randomized Controlled Trial Multicenter Study Comparative Study
Screening for posttraumatic stress disorder in VA primary care patients with depression symptoms.
Unrecognized posttraumatic stress disorder (PTSD) is common and may be an important factor in treatment-resistant depression. Brief screens for PTSD have not been evaluated for patients with depression. ⋯ Most depressed VA primary care patients report a history of trauma, and one third may have comorbid PTSD. Our 4-item screen has useful LRs for scores of 0 and 3. Modifying item rating options may improve screening characteristics.
-
Review Case Reports
Ischemic stroke, aortic dissection, and thrombolytic therapy--the importance of basic clinical skills.
Aortic dissection masquerading as ischemic stroke is particularly challenging in the era of thrombolysis as a result of narrow diagnostic time window and severe hemorrhagic potential. We describe a case of a 77-year-old patient with a presumed ischemic cerebral infarct, in whom planned treatment with tissue plasminogen activator therapy (TPA) was withheld because of partial spontaneous improvement in his condition. Shortly afterwards, newly elicited clues in the medical history and physical examination led to timely diagnosis and treatment of ascending thoracic aorta dissection, which was the underlying disorder. Analysis of the features of this case and similar previously published cases illustrates the importance of using and mastering basic diagnostic skills.
-
Comparative Study
Prevalence of interpersonal abuse in primary care patients prescribed opioids for chronic pain.
Interpersonal abuse is associated with clinical problems including chronic pain disorders. ⋯ This study reports prevalence of abuse in both men and women prescribed opioids for chronic pain in primary care settings. Subjects who report experiencing interpersonal abuse also report significantly higher rates of suicide attempts and score higher on the ASI psychiatric scale. Screening patients taking opioids for chronic pain for interpersonal abuse may lead to a better understanding of contributors to their physical and mental health.