Underutilization of Digital Rectal Examination When Screening for Prostate Cancer
Screening for prostate cancer is controversial. The American Cancer Society and American Urology Association recommend screening with digital rectal examination (DRE) and prostate-specific antigen (PSA) testing. Often, DRE is not performed and only PSA testing is done. We evaluated DRE rates in patients who had PSA testing done. We also evaluated the differences in DRE rates by provider sex and by whether they are physicians or physician extenders. We found that DRE had not been performed in about 50% of patients who had PSA testing done. Also, though the overall DRE rate was poor among all providers, female providers and physician extenders outperformed male providers and physicians, respectively.
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Treating Opioid Dependence: Growing Implications for Primary Care
Despite the important public health benefits of opioid maintenance therapy, only a minority of heroin-abusing patients are engaged in treatment. Methadone hydrochloride and levomethadyl acetate are primarily used in specialized opioid treatment programs, but buprenorphine hydrochloride has recently been approved for use in office-based practice. In the United States, there is growing interest in expanding treatment into primary care, allowing opioid addiction to be managed like other chronic diseases. This article provides a comprehensive overview of opioid dependency treatment; it focuses on the pharmacology of opioid addiction treatment with practical emphasis on the role of buprenorphine in primary care.
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Single-Payer National Health Insurance: Physicians' Views
Forty-one million Americans have no health insurance and, despite the growth of managed care, medical costs are again rising rapidly. One proposed solution is a single-payer health care financing system with universal coverage. McCormick and colleagues surveyed a random sample of 904 physicians in the state of Massachusetts (from the American Medical Association Masterfile) regarding their views on a single-payer health care financing system and other financing and physician work-life issues that such a system might affect. They found that 63% of physicians believed that a single-payer system would provide the best care for the greatest number of people, whereas only 11% supported managed care and 26% supported fee-for-service systems. The authors suggest that physicians' advocacy of single-payer national health insurance could catalyze a renewed push for its adoption.
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Depression and Cardiovascular Sequelae in Postmenopausal Women: The Women's Health Initiative (WHI)
Subclinical depression may pose increased risk of cardiovascular disease. Wassertheil-Smoller et al describe the prevalence, cardiovascular correlates, and relationship to subsequent cardiovascular events of depression measured on a screening instrument among a multiethnic cohort of nearly 100 000 generally healthy postmenopausal women enrolled in the 40 centers of the Women's Health Initiative Observational Study (WHI-OS). The WHI-OS is a long-term prospective cohort study to identify and assess the impact of biological, lifestyle, biochemical, and genetic factors for the risk of heart disease, cancer, osteoporosis, and other major health problems of older women. The reported findings pertain to women enrolled from September 1993 through December 1998 and represent the largest cohort of older women providing data on cardiovascular correlates of depression.
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