Journal of general internal medicine
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Multicenter Study Comparative Study
A comparison of the preventive health care provided by women's health centers and general internal medicine practices.
To evaluate women's health centers as alternatives to traditional internal medicine practices. ⋯ In this study, patients at women's health centers were more likely to receive gender-specific health prevention counseling than patients at internal medicine practices. Moreover, patients were more likely to receive their gender-specific preventive health services from their primary care providers.
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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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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.
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Multicenter Study
Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study.
To determine the independent contribution of admission delirium to hospital outcomes including mortality, institutionalization, and functional decline. ⋯ Delirium is an important independent prognostic determinant of hospital outcomes including new nursing home placement, death or new nursing home placement, and functional decline-even after controlling for age, gender, dementia, illness severity, and functional status. Thus, delirium should be considered as a prognostic variable in case-mix adjustment systems and in studies examining hospital outcomes in older persons.
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Multicenter Study Comparative Study Clinical Trial
Clinic HIV-focused features and prevention of Pneumocystis carinii pneumonia.
To examine the association of clinic HIV-focused features and advanced HIV care experience with Pneumocystis carinii pneumonia (PCP) prophylaxis and development of PCP as the initial AIDS diagnosis. ⋯ PCP prevention in our study cohort appears to be more successful in clinics offering an array of HIV-focused features.