Journal of general internal medicine
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Patients and physicians do not adequately discuss patients' preferences for medical care at the end of life. Our objective was to perform a qualitative study using focus groups to identify barriers and facilitators to communication about end-of-life medical care for patients with AIDS and their physicians. ⋯ Improving the quality of patient-physician communication about end-of-life care will require that physicians identify and overcome the barriers to this communication. To improve the quality of medical care at the end of life, we must address the quality of communication about end-of-life care.
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To explore potential item bias in the CAGE questions (mnemonic for cut-down, annoyed, guilty, and eye-opener) when used to screen for alcohol use disorders in primary care patients. ⋯ Despite its many advantages, the CAGE questionnaire is an inconsistent indicator of alcohol use disorders when used with male and female primary care patients of varying racial and ethnic backgrounds. Gender and cultural differences in the consequences of drinking and perceptions of problem alcohol use may explain these effects. These biases suggest the CAGE is a poor "rule-out" screening test. Brief and unbiased screens for alcohol use disorders in primary care patients are needed.
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Randomized Controlled Trial Clinical Trial
The HIV-specific advance directive.
To determine whether persons living with HIV find a disease-specific advance directive more acceptable than a generic directive. ⋯ Persons living with HIV prefer a disease-specific to a generic advance directive. They should be offered a disease-specific advance directive. Our findings should also encourage investigators to develop and evaluate disease-specific advance directives in other clinical settings.
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The objective of this project was to compare faculty productivity in teaching and nonteaching clinical settings. We hypothesized that teaching activity would have no impact on productivity. A mixed model, repeated measures analysis of variance was used to analyze average relative value units (RVUs) billed and to test for differences between clinics. ⋯ Resident supervision increased faculty productivity, while student supervision had no impact on billed RVUs. Thus, RVUs can be used as a measure of faculty clinical productivity in different settings in an academic medical center. Precepting students does not appear to affect clinical productivity.
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Editorial Comment
Insights and limitations from health-related quality-of-life research.