Joyce P. Doyle

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OBJECTIVE Management of diabetes is frequently suboptimal in primary care settings, where providers often fail to intensify therapy when glucose levels are high, a problem known as clinical inertia. We asked whether interventions targeting clinical inertia can improve outcomes. RESEARCH DESIGN AND METHODS A controlled trial over a 3-year period was(More)
PURPOSE The purpose of this study was to determine whether "clinical inertia"-inadequate intensification of therapy by the provider-could contribute to high A1C levels in patients with type 2 diabetes managed in a primary care site. METHODS In a prospective observational study, management was compared in the Medical Clinic, a primary care site supervised(More)
OBJECTIVE: We examined the relation between race/ethnicity and receipt of preventive services and the effect of having a usual source of care (USOC) on receipt of preventive services in different racial and ethnic groups. DESIGN/PARTICIPANTS: We analyzed data from adults, aged 18 to 64 years in the Household Component of the 1996 Medical Expenditure Panel(More)
BACKGROUND Although clinical trials have shown that proper management of diabetes can improve outcomes, and treatment guidelines are widespread, glycated hemoglobin (HbA1c) levels in the United States are rising. Since process measures are improving, poor glycemic control may reflect the failure of health care providers to intensify diabetes therapy when(More)
OBJECTIVE To determine the factors and reasons associated with lack of interest in HIV testing among older women from a high prevalence community. METHODS We conducted a cross-sectional study of women aged >or=50 seeking medical care. The main outcome measures were (1) interest in HIV testing and (2) reasons for women's interest or lack of interest(More)
BACKGROUND Recently our group reported on the shrinkage of 199 malignant melanoma surgical-excision specimens. In that report, a multivariate analysis revealed that the age of the patient was the only factor that significantly affected the percentage shrinkage of a surgical specimen. In addition, a formula was presented that extrapolates the actual surgical(More)
One hundred and twenty infants with infantile hypertrophic pyloric stenosis were operated on by two consultant general surgeons over a 13-year period. General anaesthetic and a standard surgical approach was used in all cases. No mortality was recorded and there were no wound dehiscences. The overall postoperative wound infection rate was 9.2%. Prior to(More)
The shrinkage of cutaneous surgical specimens of 199 malignant melanomas was analyzed. A formula was derived that makes it possible to calculate the in vivo (preexcision) specimen diameter from the in vitro (fixed-tissue) specimen diameter. The age of the patient was found to significantly influence specimen shrinkage and was incorporated into this(More)
The performance of a general exploratory laparotomy immediately after opening the abdominal cavity has long been a foundation of surgical practice. Since the introduction of laparoscopy, this procedure has been modified. This may result in certain intra-abdominal pathologies being overlooked, especially in areas that are hard to observe with the(More)
OBJECTIVES To assess older urban women's knowledge about sexual transmission of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and to evaluate the relationship between their HIV/AIDS knowledge level and sources of information. DESIGN Cross-sectional survey conducted between June 2001 and July 2002. Trained research(More)