Journal of general internal medicine
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To develop, within the framework of continuous quality improvement, new processes for offering mammography and determine whether protocols executed completely by nonphysicians would increase mammography utilization. ⋯ Redesigning clinic processes to make offering of mammography by medical assistants and licensed practical nurses a routine part of the clinic encounter can lead to mammography rates that are superior to those seen in physicians' usual practice, even when screening levels are already fairly high. Physicians need not be considered the sole, or even the primary, member of the health care team who can effectively deliver some preventive health measures.
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Meta Analysis
The efficacy of selective serotonin reuptake inhibitors for the management of chronic pain.
To assess the effectiveness of selective serotonin reuptake inhibitors (SSRIs) in the management of chronic pain. ⋯ SSRIs appear to be beneficial for mixed-chronic pain. It is unclear, from the available evidence, whether SSRIs are beneficial for migraine headaches, tension headaches, diabetic neuropathy, or fibromyalgia. For those patients it may be reasonable to reserve SSRIs for those who fall to respond to other medications or who are intolerant of their side effects.
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Meta Analysis
Meta-analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers.
To assess the effectiveness of brief interventions in heavy drinkers by analyzing the outcome data and methodologic quality. ⋯ Heavy drinkers who received a brief intervention were twice as likely to moderate their drinking 6 to 12 months after an intervention when compared with heavy drinkers who received no intervention. Brief intervention is a low-cost, effective preventive measure for heavy drinkers in outpatient settings.
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To determine whether patient preferences for the use of coronary revascularization procedures differ between white and black Americans. ⋯ Racial differences in revascularization rates may be due in part to differences in patient preferences. However, preferences were more closely related to questions assessing various aspects of familiarity with the procedure. Patients of all races may benefit from improved communication regarding proposed revascularization. Further research should address this issue in patients contemplating actual revascularization.