Journal of general internal medicine
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Multicenter Study Comparative Study
Clinical examination for the detection of protective sensation in the feet of diabetic patients. International Cooperative Group for Clinical Examination Research.
We compared the reproducibility and accuracy of conventional clinical examination of the diabetic foot to monofilament examination. We also sought to simplify the monofilament examination by reducing it to fewer touch points. ⋯ Conventional clinical examination had low reproducibility and correlated poorly with monofilament examination for the identification of the at-risk patient. The Semmes-Weinstein monofilament examination, a reproducible, valid, and generalizable test of foot sensation, is recommended as the screening procedure of choice for examining diabetic feet.
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To examine associations of patient ratings of communication by health care providers with patient language (English vs Spanish) and ethnicity (Latino vs white). ⋯ This study documents that Latino/Spanish respondents are significantly more dissatisfied with provider communication than Latino/English and white respondents. These results suggest Spanish-speaking Latinos may be at increased risk of lower quality of care and poor health outcomes. Efforts to improve the quality of communication with Spanish-speaking Latino patients in outpatient health care settings are needed.
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Editorial Review
Statistically derived predictive models. Caveat emptor.
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Comparative Study
Rewards and incentives for nonsalaried clinical faculty who teach medical students.
We surveyed the clerkship administrators of pediatrics, family medicine, and internal medicine at U. S. medical schools, and of pediatrics at Canadian medical schools to determine what rewards and incentives are being offered to nonsalaried faculty for office-based teaching. ⋯ Nonmonetary rewards like educational opportunities were offered by 70% to 89%; academic appointments by 90% to 95%; special recognition events by 62% to 79%; and appreciation letters by 74% to 84% of programs. Only 3 of 338 responders offered no rewards or incentives.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Validation of the pneumonia severity index. Importance of study-specific recalibration.
To evaluate the predictive validity and calibration of the pneumonia severity-of-illness index (PSI) in patients with community-acquired pneumonia (CAP). ⋯ We found that the PSI had good discriminatory ability. The original PSI overestimated absolute risk of death in our population. We describe a simple approach to recalibration, which corrected the overestimation in our population. Recalibration may be needed when transporting this prediction rule across populations.