Journal of general internal medicine
-
Comparative Study
Physicians' initial management of acute low back pain versus evidence-based guidelines. Influence of sciatica.
Little information is available on physician characteristics and patient presentations that may influence compliance with evidence-based guidelines for acute low back pain. ⋯ A majority of primary care physicians continue to be noncompliant with evidence-based back pain guidelines. Sciatica dramatically influenced clinical decision-making, increasing the extent of noncompliance, particularly for internal medicine and family practice. Physicians' misunderstanding of sciatica's natural history and belief that more intensive initial management is indicated may be factors underlying the observed influence of sciatica.
-
Although a variety of validity evidence should be utilized when evaluating assessment tools, a review of teaching assessments suggested that authors pursue a limited range of validity evidence. ⋯ Content and Internal Structure evidence is well represented among published assessments of clinical teaching. Evidence for Relation to Other Variables, Consequences, and Response Process receive little attention, and future research should emphasize these categories. The low interrater reliability for Response Process and Consequences likely reflects the scarcity of reported evidence. With further development, our method for rating the validity evidence should prove useful in various settings.
-
Comparative Study
Chlamydia screening and management practices of primary care physicians and nurse practitioners in California.
Because sexually transmitted chlamydial infections are common among young women, it is critical that providers screen and manage these infections appropriately. ⋯ The Chlamydia care practices of many California primary care providers are inconsistent with current guidelines. Targeted provider education and improved reimbursements are potential strategies for improvement.
-
Black women have a disproportionately higher incidence of cardiovascular disease mortality than other groups and the reason for this health disparity is incompletely understood. Underestimation of personal cardiac risk may play a role. ⋯ Urban, disadvantaged black women in this study had many cardiac risk factors, yet routinely underestimated their risk of heart disease. We found that the strongest correlates of underestimation were perceived stress and lower personal income.