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Effective Clinical Practice

May/June 2002

ORIGINAL ARTICLE

Gluten-Free Diet and Quality of Life in Patients with Screen-Detected Celiac Disease
Kirsi Mustalahti, Susanna Lohiniemi, Pekka Collin, Nanna Vuolteenaho, Pekka Laippala, and Markku Mäki

The development of serologic testing has made it possible to screen for celiac disease. However, the benefits of screening have not been established and a number of potential harms have been identified, including the burden of a gluten-free diet. In this report, the authors show that a gluten-free diet is acceptable and may even improve quality of life for patients with screen-detected disease.
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Use and Evaluation of Critical Pathways in Hospitals
Jonathan Darer, Peter Provonost, and Eric B. Bass

A cross-sectional survey of academic and community hospitals shows that use of critical pathways varies substantially. Developing and maintaining pathways is expensive; nevertheless, few institutions track the data needed to evaluate the clinical and economic impact of these pathways.
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How Underlying Patient Beliefs Can Affect Physician-Patient Communication about Prostate-Specific Antigen Testing
Michael H. Farrell, Margaret Ann Murphy, and Carl E. Schneider

Men who had counseling about prostate-specific antigen (PSA) cited underlying beliefs rather than content of counseled information as the basis for their decisions regarding future PSA testing. This calls into question whether decision aids and other efforts to optimize counseling are as meaningful as is widely believed, especially for men who have been previously tested or have past knowledge of PSA.
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PATTERNS OF PRACTICE

Tobacco-Control Policies in 11 Leading Managed Care Organizations: Progress and Challenges
Nancy A. Rigotti, Virginia P. Quinn, Victor J. Stevens, Leif I. Solberg, Jack F. Hollis, Abby C. Rosenthal, Jane G. Zapka, Eric France, Nancy Gordon, Sabina Smith, and Mina Monroe

Even leading health plans could do more to comply with national practice guidelines of tobacco-dependence treatment and make it easier for clinicians to help patients stop smoking.
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Prostate Biopsies in Men with Limited Life Expectancy
John H. Wasson, Thomas A. Bubolz, Grace Lu Yao, and Michael J. Barry

Men with a life expectancy of less than 10 years are unlikely to benefit from prostate biopsy or subsequent treatment. Nevertheless, many men with limited life expectancy undergo prostate biopsy. It is particularly important to inform men with a limited life expectancy of the pros and cons of PSA screening.
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SPECIAL TOPIC

The Healthcare Cost and Utilization Project: An Overview
Claudia Steiner, Anne Elixhauser, and Jenny Schnaier

The Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Quality and Research, is a family of databases that includes multistate, inpatient and outpatient discharge records on insured and uninsured persons. This practical guide is intended to help researchers use these databases.
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ENDNOTE

H. Gilbert Welch, MD, MPH
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WEB ONLY ARTICLES

The Medical Expenditure Panel Survey: An Overview
Steven B. Cohen, PhD, Center for Cost and Financing Studies, Agency for Healthcare Research and Quality, Rockville, Md
Full Text

The National Health Interview Survey: An Overview
Jane F. Gentleman, PhD, John R. Pleis, MS, Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md
Full Text

Using the National Health Interview Survey: Time Trends in Influenza Vaccinations among Targeted Adults
John R. Pleis, MS, Jane F. Gentleman, PhD, Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md
Full Text

Veterans Health Administration Inpatient and Outpatient Care Data: An Overview
Patricia A. Murphy, MS, Diane C. Cowper, MA, Gregg Seppala, MA, Kevin T. Stroupe, PhD, Denise M. Hynes, PhD
Full Text

Using the Veterans Health Administration Inpatient Care Database: Trends in the Use of Antireflux Surgery
Samuel R.G. Finlayson, MD, MPH, Kevin T. Stroupe, PhD, George J. Joseph, MS, Elliott S. Fisher, MD, MPH
Full Text

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Note: Due to budgetary pressures on our sponsors, the American College of Physicians-American Society of Internal Medicine and the Alliance of Community Health Plans, Effective Clinical Practicewill not be published in its current format past the May/June 2002 issue.

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