No abstract

OBJECTIVE:To perform a meta-analysis on existing randomized controlled trials to investigate the efficacy of patient letter reminders on increasing cervical cancer screening using Pap smears. METHODS:A search was conducted for all relevant published and unpublished studies between the years 1966 and 2000. Eligibility criteria included randomized controlled studies that examined populations due for Pap smear screening. The intervention studied was in the form of a reminder letter. The Mantel-Haenszel method was used to measure the summary effect of the intervention. A test for homogeneity using the Mantel-Haenszel method was performed. RESULTS:Ten articles fulfilled the inclusion criteria, including one unpublished study. The test for homogeneity showed evidence of heterogeneity ( 2 = 31, 9 df, P < .001). An analysis for causes of heterogeneity was pursued. Division into subpopulations based on socioeconomic status resolved the heterogeneity ( 2 = 5.2, 8 df, P = .75). The studies evaluating those in lower socioeconomic groups had a smaller response (odds ratio [OR], 1.16; 95% confidence interval [CI ], 0.99 to 1.35) than those studies using mixed populations (OR, 2.02; 95% CI, 1.79 to 2.28). The pooled odds ratio showed that patients who received the intervention were significantly more likely to return for screening than those who did not (OR, 1.64; 95% CI, 1.49 to 1.80). E arly detection of cervical cancer through screening can lower mortality by 20% ± 60%. 1 Despite public health education on the benefits of screening for cervical cancer, the overall percentage of women who had a recent Pap test according to the Centers for Disease Control and Prevention's National Health Interview Survey between 1987 and 1992 remained at 67%. 2 Certain subpopulations have been found to lag behind the general population in cervical cancer screening rates. Those less likely to be screened include the elderly, women living in rural areas, non±English-speaking Hispanics, those below the poverty index, and women with less than a high school education. 3 Interventions to improve Pap smear screening have had mixed results, with some studies finding significant improvement in screening while others only a modest benefit, if any. We are aware of only one other metaanalysis specifically dealing with patient reminders for cervical cancer screening. 4 This meta-analysis, which pooled 6 studies, found that women had a higher likelihood of obtaining a Pap smear if they received reminders. But there was marked heterogeneity in the pooled studies so that the significance of the results was unclear. The authors did not pursue an examination for sources of heterogeneity. We found 2 additional metaanalyses of letter reminder interventions. A metaanalysis on reminders promoting mammography found an improvement in mammography completion rates using a letter intervention (OR, 1.48; P < .001). 5 However, this study also had evidence of heterogeneity that could not be explained. A meta-analysis of computer-based reminder systems using physician and ...

No abstract

Surgeons write 1.8% of all prescriptions and 9.8% of all opioid prescriptions. Of a total of 180 patients (median age 63 years), 127 did not receive opioids; 53 were prescribed opioids against protocol. The operating surgeon was the only variable independently correlated with protocol adherence. Ambulatory breast surgery patients tolerated a nonopioid pain regimen well. Surgeons' decisions, rather than patient characteristics, primarily drove the choice of pain management in our study.

Injuries were similar to those seen with other light-to-moderate outdoor physical activities. Given KPNC's membership of 3.85 million, the number of severe injuries reported was low; this suggests that the game is safe to play. Pokémon Go may be reaching a population that requires increased physical activity.