Table of Contents
The Issue in Brief
May-June 2004
Cumulative list of Issues In Brief
A
Adjusted Chi-Square Statistics: Application to Clustered Binary Data in Primary Care
By James F. Reed, III, PhD
A primary care research study can involve data at both group and individual levels. An approach for analyzing this "clustered"
data is presented.
What Is an Intracluster Correlation Coefficient? Crucial Concepts for Primary Care Researchers
By Shersten Killip, MD, MPH, and colleagues
A primary care research study can involve data at both group and individual levels. It is important for researchers to recognize
and understand the ways in which this "clustering" can affect their analyses of data.
Quantifying Risk of Adverse Clinical Events With One Set of Vital Signs Among Primary Care Patients with Hypertension
By William M. Tierney, MD, and colleagues
A blood pressure reading includes two numbers: systolic blood pressure (the first number), which is measured after a heart
beat, and diastolic blood pressure (the second number), which is measured between heart beats. A single finding of high systolic
blood pressure can be a sign of increased risk of stroke, heart disease, heart attack, or kidney failure.
Accuracy of Screening for Diabetic Retinopathy by Family Physicians
By James M. Gill, MD, and colleagues
People with diabetes are at risk for an eye disease called diabetic retinopathy. Using a new type of ophthalmoscope (a magnifying
instrument) and following new guidelines can help primary care doctors identify possible cases of diabetic retinopathy. Although
all people with diabetes should be examined regularly by an eye specialist, this technique can help improve care for patients
who do not get routine eye exams.
A Randomized Clinical Trial OF The Effect of Intra-Operative Saline Perfusion on Postvasectomy Azoospermia
By Timothy G. Schuster, MD, and colleagues
After a vasectomy, it can take up to 4 months before sperm are absent from the semen. Flushing one end of the vas deferens
(the tube that connects the testicles and the prostate gland) with a saline solution does not change the number of sperm present
after vasectomy or decrease the time before sperm are absent.
Patient Pain in Primary Care: Factors that Influence Physician Diagnosis
By Klea D. Bertakis, MD, MPH, and colleagues
It is sometimes difficult for medical professionals to recognize a patient's pain. Pain is more often recognized in patients
with severe pain and in female patients. Physicians who focus on the technical aspects of care and on a patient's health behaviors
are more likely to diagnose pain.
Medical Management of Intimate Partner Violence Considering the Stages of Change: Precontemplation and Contemplation
By Therese Zink, MD, MPH
Physicians can assist women who experience physical abuse but are not yet ready for help by inquiring about violence, looking
for clues that the patient might provide, and having resources available when the woman is ready for help.
Consumer Knowledge of Over-the-Counter Phenazopyridine
By Chih-Wen Shi, MD, MSHS, and colleagues
Many consumers have a poor understanding of the purpose of a widely-used drug called phenazopyridine. The drug, which is available
without a prescription, is used to treat pain associated with urinary tract infections. Better education and monitoring of
people who use over-the-counter drugs could help assure that the drugs are used correctly.
Referral of Patients to Specialists: Factors Affecting Choice of Specialist by Primary Care Physicians
By Kraig S. Kinchen, MD, MSc, and colleagues
Primary care physicians consider several factors when choosing a specialist for a patient referral. The specialist's medical
skill is the most important factor. Other major considerations include the primary care physician's previous experience with
the specialist and the timeliness of the patient's appointment.
What Complementary and Alternative Medicine Practitioners Say About Health and Health Care
By Bruce Barrett, MD, PhD, and colleagues
Practitioners of complementary and alternative medicine express a desire to work with physicians and other conventional clinicians.
They believe that medicine should be more caring, patient-centered, empowering, and holistic.
Screening for Ovarian Cancer: Recommendation Statement
By U.S. Preventive Services Task Force
The U.S. Preventive Services Task Force recommends against routine screening for ovarian cancer because of findings that the
potential harms outweigh the potential benefits. The new recommendation reflects no change from its 1996 recommendation against
routine ovarian cancer screening. The Task Force found no existing evidence that any screening test reduces deaths from ovarian
cancer. The Task Force also considered the low rates of ovarian cancer among women and the high rates of "false-positive"
(incorrect) test results.
Screening for Visual Impairment in Children Younger than Age 5 Years: Recommendation Statement
The most common vision problems in children are amblyopia (dimness of vision or "lazy eye"), nearsightedness, and farsightedness.
According to a new U.S. Preventive Services Task Force recommendation, children under the age of 5 years should be tested
for amblyopia, strabismus ("crossed eyes" in which the eyes do not look in the same direction), and visual acuity (the ability
to distinguish details and shapes of objects). Early detection and treatment of amblyopia can improve visual acuity. Left
uncorrected, it may harm school performance, ability to learn, and self-image, and it may be a risk factor for blindness.
What Can Family Physicians Offer Patients With Carpal Tunnel Syndrome Other Than Surgery? A Systematic Review of Nonsurgical
Management
By Felicity Goodyear-Smith, MB, ChB, MGP, and colleague
Carpal tunnel syndrome, which involves pressure on the median nerve in the wrist, can result in numbness, weakness, and pain
in the hand or arm. In about half of cases, symptoms go away without treatment. Medications called corticosteroids have been
shown to be provide short-term relief for people with carpal tunnel syndrome. Corticosteroids, however, have possible side
effects. Surgery can be very effective in treating carpal tunnel syndrome, especially if it is done early in the course of
the condition.