Journal of general internal medicine
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To determine 1) whether young adult black patients in an emergency department (ED) are familiar with sickle-cell anemia and 2) how many of these patients know their own sickle-cell trait status. ⋯ Most black patients of childbearing age presenting to the ED have heard of sickle-cell anemia and know that it runs in families, but few know their own trait status. Until access to primary care providers is improved, ED physicians who care for patients at risk for sickle-cell trait have an obligation to ask them about prior screening and either screen them or refer them for screening.
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Since inordinately long or short lengths of stay at hospice can create problems for patients, providers, and payers, the author sought to identify predictors of timing of patient referral. ⋯ Inappropriately early or late referral occurs in a substantial minority of patients referred to the hospice under study. Closer attention to accurate prognostication in different types of terminally ill patients and more timely referral to hospice might help to optimize the use of this health care resource from both patient and societal perspectives.
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To determine the response of physicians to a noncoercive prediction rule for the triage of emergency department patients with chest pain. ⋯ The physicians reported that they looked at the prediction rule during the triage of 115 (46%) of the 252 patients. The likelihood of using the prediction rule decreased significantly with increasing level of physician training. The most common reasons given for disregarding the prediction rule were confidence in unaided decision making and lack of time. The physicians reported that of the 115 cases for which the prediction rule was used, only one triage decision (1%) was changed by it. Future research should explore how prediction rules can be designed and implemented to surmount the barriers highlighted by these data.
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Comparative Study
Addressing alcohol use among primary care patients: differences between family medicine and internal medicine residents.
To determine whether rates of addressing alcohol use differed between family medicine and internal medicine residents, and to determine whether attitudes, confidence, and perceptions affected these relationships. ⋯ Rates of addressing alcohol use differed for internal medicine and family medicine residents, but were not due to differences in resident perceptions and attitudes.
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This paper describes teaching and learning methods that can be used to build the competencies needed by the generalist physician. Supervised patient care, problem-based learning, and ongoing feedback through standardized patients all have proven efficacy in several domains. ⋯ The authors review each method's principles, relationship to generalist competencies, examples of effective applications, and challenges to successful implementation. Where possible, they summarize what is known about the relationships of learning and teaching methods to career choices in generalism.