Elder abuse research: a systematic review.

The purpose of this research was to provide a systematic review of, and assign an evidence grade to, the research articles on elder abuse. Sixteen health care and criminal justice literature databases were searched. Publications were reviewed by at least two independent readers who graded each from A (evidence of well-designed meta-analysis) to D (evidence from expert opinion or multiple case reports) on the quality of the evidence gained from the research. Of 6,676 titles identified in the search, 1,700 publications met inclusion criteria; omitting duplicates, 590 publications were annotated and graded.

Primary care clinicians' perspectives on management of skin and soft tissue infections: an Iowa Research Network study.

UNLABELLED: An estimated 95,000 people developed methicillin-resistant Staphylococcus aureus (MRSA) infections during 2005 of which 14% were community-associated and 85% were hospital or other health setting associated, and 19,000 Americans died from these infections that year. PURPOSE: To explore health care providers' perspectives on management of skin and soft tissue infections to gain a better understanding of the problems faced by busy providers in primary care settings. METHODS: Focus group meetings were held at 9 family physician offices in the Iowa Research Network. Seventy-eight clinicians including physicians, nurses, nurse practitioners, and house officers attended. Meeting audiotapes were transcribed and coded by 3 investigators, and a MRSA-management taxonomy was developed. FINDINGS: The main themes that emerged from the focus groups included epidemiology, diagnosis, treatment, management, prevention, special populations, and public relations. The incidence of MRSA infections was perceived to have increased over the past decade. However, diagnosis and treatment protocols for physicians in the outpatient setting have lagged behind, and no well-accepted diagnostic or treatment algorithms were used by physicians attending the focus groups. CONCLUSION: The clinicians in this study noted considerable confusion and inconsistency in the management of skin and soft tissue infections, particularly those due to MRSA.

Mailed fecal-immunochemical test for colon cancer screening.

Various interventions have been implemented to increase the rate of colon cancer screening. The purpose of this study was to determine if persons who are regular patients of a clinic, ages 50-64 years, and not up-to-date with colon cancer screening will complete the at-home fecal-immunochemical test (FIT) if it is mailed to them. This intervention was designed to have the subject avoid the signing of an informed consent and having to ask for the screening test; and, only one stool specimen was needed. Three hundred and fifty potential subjects were randomly selected from an electronic medical record database after meeting inclusion criteria. Eighty-seven fecal immunochemical tests were returned. Seven of the FIT kit results were positive for occult blood. Each respondent was sent a letter giving them their results. A minimal cue CRC screening intervention, a FIT kit sent in the mail without prerequisite of a signed informed consent, was offered to the study subjects. Twenty-six percent of the eligible persons were screened for colon cancer by this method. A mailed FIT kit or one handed to the patient at an office visit has minimal cost which can be recovered through insurance coverage. Commitment by health care providers is necessary for prevention. This method is one of several that could reach the hard to screen population.

The "Iowa get screened" colon cancer screening program.

OBJECTIVE: To implement a colon cancer screening program for uninsured or underinsured Iowans. METHODS: All 1995 uninsured patients or patients with Iowa Care insurance aged 50 to 64 years attending the University of Iowa Clinic or the Iowa City Free Medical Clinic were mailed information about the project. Recruitment also took place in person, by having the clinic receptionist hand subjects a research packet, and through community posters. Individuals with colonic symptoms or who were up to date with screening were ineligible. Eligible subjects received a free fecal immunochemical test (FIT), and those with positive FITs were provided with a colonoscopy at no cost to them. RESULTS: Of 449 individuals who completed eligibility forms (23% of the study population), 297 (66%) were eligible and were provided with an FIT. Two-hundred thirty-five (79%) returned a stool sample, with 49 (21%) testing positive. Thirty of the 49 (61%) individuals had a colonoscopy, and 20 individuals had at least 1 polyp biopsied. Thirteen individuals had at least 1 tubular adenoma; 2 had adenomas more than 1 cm in diameter, with no colon cancers identified. Face-to-face recruitment had the highest rate of returned FITs (72%) compared with handing the subject a research packet (3%) or a mailing only (9%) (Chi-square, P < .001). CONCLUSION: There was high interest in and compliance with colon cancer screening using a FIT among underinsured individuals. Although the FIT positivity rate was higher than expected, many individuals did not complete recommended follow-up colonoscopies. Population-based strategies for offering FIT could significantly increase colon cancer screening among disadvantaged individuals, but programs will have to develop sustainable mechanisms to include the necessary organization and address substantial costs of providing mass screening, as well as facilitating and providing colonoscopies for those who test positive.

An assessment of attitudes, behaviors, and outcomes of patients with type 2 diabetes.

OBJECTIVES: Patient self-care behaviors, including taking medication, following a meal plan, exercising regularly, and testing blood glucose, influence diabetes control. The purpose of this research was to identify (1) which barriers to diabetes management are associated with problem behaviors and (2) which patient behaviors and barriers are associated with diabetes control. METHODS: This was a cross-sectional study of linked medical record and self-reported information from patients with type 2 diabetes. A randomly selected sample of 800 clinic patients was mailed an investigator-developed survey. The study sample consisted of 253 (55%) individuals who had measured glycosylated hemoglobin (HbA1c) within 3 months of the survey date. RESULTS: The barriers to each diabetes self-care behavior differed. Cost was the most common barrier to the 4 self-care behaviors. In a multivariable regression model, the belief that type 2 diabetes is a serious problem and depression were strongly associated with higher HbA1c levels. Lower HbA1c levels were significantly associated with being married and greater self-reported adherence-satisfaction with taking medication and testing blood glucose. CONCLUSION: This study expanded earlier research by focusing on 4 specific self-care behaviors, their barriers, and their association with HbA1c. Barriers that were significantly associated with HbA1c were specific to the behavior and varied across behaviors.

Factors associated with higher clinical skills experience of medical students on a family medicine preceptorship.

BACKGROUND AND OBJECTIVES: Educators should document students' clinical skills experience and whether curriculum and other course changes impact this experience. We wanted to determine the factors associated with students' clinical skills experience during their third-year family medicine preceptorship. METHODS: We conducted an observational study of 1,419 third-year students at the University of Iowa taking a required family medicine preceptorship during 9 academic years: 1994-1995 to 2002-2003. Students rated their level of experience with 57 clinical skills on a 5-point scale. Student ratings were summed to obtain scores for total clinical skills (n=57), procedural skills (n=22), and female-specific skills (n=9). RESULTS: Students who completed their preceptorship in rural areas (as opposed to urban areas or in a residency), prior to the implementation of Centers for Medicare and Medicaid Services regulations, prior to integration with ambulatory internal medicine and community-based primary care, or who rotated during the second half of the academic year reported a higher mean level of experience with clinical skills in univariate and multivariate analyses. Both years of experience as a preceptor and total number of previous students taught were positively associated with students' total clinical skills scores. In addition, several preceptor teaching qualities were significantly and positively associated with overall skills experience: opportunity for clinical procedures, delegation of appropriate responsibility, and preceptor conveyed expectations clearly. CONCLUSIONS: Use of a consistent clinical skills checklist allowed us to document important effects of curriculum, legislation, and preceptor teaching qualities on the students' clinical skills experience.

Differences in clinical experiences based on gender of third-year medical students in a required family medicine preceptorship.

PURPOSE: To investigate whether the gender of a student or preceptor affects the students' level of experience with clinical skills in a preceptorship. METHOD: A total of 451 third-year medical students completed a required family medicine preceptorship during three academic years (1997-2000) at one medical school. Students recorded their highest levels of experience with 57 clinical skills at the completion of the preceptorship using a five-point scale. Mean levels of experience were compared according to student and preceptor gender and by student-preceptor gender dyads. RESULTS: For the majority of clinical skills, levels of experience did not differ according to gender of the student or preceptor. However, women students received more experience with seven of 12 female-specific skills and men students received more experience with two of three male-specific skills. Women preceptors provided more experience with seven of 12 female-specific skills, as well as with depression and anxiety; men preceptors provided more experience with procedures. For the vast majority of gender-specific skills, the highest levels of student experience were received by pairs of students and preceptors of the same gender who were seeing patients of their same gender; the lowest levels of experience occurred in student-preceptor pairs of the same gender seeing patients of the opposite gender. There was no evidence for student-preceptor interactions. CONCLUSIONS: The gender of a student and that of the preceptor affect the level of experience the student receives with a number of gender-specific skills and procedures. Ways should be found to minimize these differences in training.