Abstract:
BACKGROUND:Rapid antigen detection tests (RADT) are commonly used to guide appropriate antibiotic treatment of group A beta-hemolytic streptococcal (GABHS) pharyngitis. In adults, there is controversy about the need for routine backup testing of negative RADT. OBJECTIVE:Estimate the costs and benefits in adults of routine backup testing by DNA Gen-probe of negative RADT (Acceava). DESIGN:Observational follow-up study. PARTICIPANTS:All patients aged 18 years and older visiting a Cleveland Clinic generalist physician in 2009 and 2010 with a visit diagnosis of acute pharyngitis (ICD codes 462, 034.0). MAIN MEASURES:The patients were identified using the Cleveland Clinic Epic Clarity database. We determined the proportion of false negative RADT, antibiotic prescription patterns and rate of serious suppurative complications within 30 days of the office visit. KEY RESULTS:Of 25,130 patients with acute pharyngitis, 19% had no testing and 81% were tested. Of the 15,555 patients that had a negative RADT and follow-up DNA probe, 6% had a positive DNA probe. Of the 953 patients who had a negative RADT and a positive DNA strep probe, 48% received an antibiotic prescription at the time of the visit and 51% received an antibiotic prescription after an average of 2.3 days. Only one patient with a negative RADT and no follow-up DNA probe developed a peritonsillar abscess. Overall, of the 15,555 DNA probes performed, management was altered in only 3% of the patients at a total cost of $1,757,715. Fifty-six percent received an antibiotic while only 19.5% had a confirmed strep throat diagnosis. CONCLUSIONS:The false negative rate of Acceava RADT for the diagnosis of GABHS pharyngitis was 6%. We question the benefit of routine DNA probe backup testing in adults because of its substantial cost, an average delay in antibiotic prescribing of over 2 days, and because suppurative complications are very uncommon. We found a high rate of inappropriate antibiotic prescribing.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Nakhoul GN,Hickner Jdoi
10.1007/s11606-012-2245-8subject
Has Abstractpub_date
2013-06-01 00:00:00pages
830-4issue
6eissn
0884-8734issn
1525-1497journal_volume
28pub_type
杂志文章abstract::Intravascular hemolysis is a rare but potentially life threatening cause of red urine characterized by brisk hemolysis and release of large amounts of hemoglobin into the urine. We present an unusual case of red urine in a 20-year-old male who was subsequently diagnosed with intravascular hemolysis due to an aorto-atr...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-010-1430-x
更新日期:2010-12-01 00:00:00
abstract::Evaluations of intensive care have largely focused on survival, cost, or functional status; however, these may not be the only outcomes of interest to patients, families, and health care providers. Quality of life is an important consideration in evaluating intensive care because it influences decisions about the use ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02596335
更新日期:1988-05-01 00:00:00
abstract::The fourth-year medicine clerkship was restructured at one of four sites. Teams consisting of one attending physician and three students cared for eight new patients per week. The overall experience of the restructured clerkship was rated significantly more positively than the experiences at all other sites and the te...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
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abstract:BACKGROUND:As the Veterans Health Administration (VHA) reorganizes providers into the patient-centered medical home, questions remain whether this model of care can demonstrate improved patient outcomes and cost savings. OBJECTIVE:We measured adoption of medical home features by VHA primary care clinics prior to wides...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-013-2405-5
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Early in medical education, physicians must develop competencies needed for tobacco dependence treatment. OBJECTIVE:To assess the effect of a multi-modal tobacco dependence treatment curriculum on medical students' counseling skills. DESIGN:A group-randomized controlled trial (2010-2014) included ten U.S. ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s11606-015-3508-y
更新日期:2016-02-01 00:00:00
abstract:OBJECTIVES:To develop and evaluate a web-based curriculum to introduce first year medical students to the knowledge and attitudes necessary for working with limited English proficient (LEP) patients through interpreters. METHOD:Six hundred and forty first year medical students over 4 consecutive years took this curric...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2005.0193.x
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVE:To determine whether echocardiography affects the decisions to use beta blockers or to recommend bacterial endocarditis prophylaxis in patients suspected of having mitral valve prolapse (MVP). DESIGN:Retrospective review of echocardiograms and clinical records. SETTING:Military tertiary care hospital. PATI...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
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更新日期:1990-11-01 00:00:00
abstract:OBJECTIVE:To measure primary care physicians' familiarity with, attitudes toward, and confidence in preventive care practice guidelines for the elderly and to determine whether their attitudes are associated with implementation of guidelines into clinical practice. DESIGN:A self-administered survey of physicians emplo...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599668
更新日期:1995-03-01 00:00:00
abstract::Because of the financial incentives of prepaid care, the quality of care for Medicare enrollees in Health Maintenance Organizations (HMOs) is a concern. Therefore, the care in 150 newly diagnosed cases of colorectal cancer in eight HMOs was compared with that in 180 similar fee-for-service (FFS) cases. As part of the ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600509
更新日期:1990-03-01 00:00:00
abstract:BACKGROUND:Many Americans lack health insurance. Despite good evidence that lack of insurance compromises access to care, few prospective studies examine its relationship to health outcomes. OBJECTIVE:To determine the relationship between insurance and cardiovascular outcomes and the relationship between insurance and...
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doi:10.1007/s11606-007-0127-2
更新日期:2007-04-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0260-y
更新日期:2007-09-01 00:00:00
abstract::Hospital discharges against medical advice (AMA) are common, costly, stigmatizing to patients, and are associated with excess morbidity and mortality. Achieving better quality care for patients discharged AMA has been limited both by the sparse research illuminating how best to care for this challenging patient popula...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-013-2540-z
更新日期:2013-12-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0474-z
更新日期:2008-02-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:2004-10-01 00:00:00
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pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-014-2768-2
更新日期:2014-05-01 00:00:00
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doi:10.1111/j.1525-1497.2006.00532.x
更新日期:2006-08-01 00:00:00
abstract::Over the past several decades, and particularly during the last 10 to 15 years, there has been a rapid increase in the accessibility of legalized gambling in the United States and other parts of the world. Few studies have systematically explored the relationships between patterns of gambling and health status. Existi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1046/j.1525-1497.2002.10812.x
更新日期:2002-09-01 00:00:00
abstract:BACKGROUND:It is assumed that the performance of more senior residents is superior to that of interns, but this has not been assessed objectively. OBJECTIVE:To determine whether adherence to national guidelines for outpatient preventive health services differs by year of residency training. DESIGN:Cross-sectional stu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2005.0158.x
更新日期:2005-09-01 00:00:00
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journal_title:Journal of general internal medicine
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abstract::The authors evaluated the perceptions and adjustments of surviving spouses following patient deaths. Of 128 married patients dying in a university hospital in 1983, the surviving spouses of 105 (82%) were personally interviewed a year after the death. The physicians' perspectives were recorded through chart review. Ha...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
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更新日期:1986-09-01 00:00:00
abstract:BACKGROUND:The Veterans Access, Choice and Accountability Act (hereafter, Choice Program) seeks to improve access to care by enabling eligible Veterans to receive care from community providers. Veterans Affairs (VA) primary care providers (PCPs) play a key role in making referrals to community specialists, but their fr...
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更新日期:2019-04-01 00:00:00
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journal_title:Journal of general internal medicine
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doi:10.1007/s11606-016-3608-3
更新日期:2016-06-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1997.00057.x
更新日期:1997-06-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
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更新日期:2007-05-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2000.06439.x
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.30065.x
更新日期:2004-05-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-04882-2
更新日期:2019-05-01 00:00:00