Richard J Pels

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Using criteria adopted by the US Preventive Services Task Force, we evaluated use of the dipstick urinalysis to screen for bacteriuria. When the leukocyte esterase and nitrite dipstick tests are combined, the positive predictive value for detecting bacteriuria exceeded 12% in groups with a 5% or higher prevalence of bacteriuria: women who are pregnant,(More)
We review evidence on the value of dipstick urinalysis screening for hemoglobin and protein in asymptomatic adults. In young adults, evidence from five population-based studies indicates that fewer than 2% of those with a positive heme dipstick have a serious and treatable urinary tract disease, too few to justify screening and the risks of subsequent(More)
PURPOSE Competence in the psychosocial aspects of medical care is necessary for primary care physicians to function effectively. This study investigated the psychosocial training internal medicine and family practice residents receive in U.S. programs. METHODS In 1996, program directors of all U.S. internal medicine (IM) and family practice (FP) residency(More)
A semiotic conceptualization of pain in the chronic pain syndrome is proposed. It is suggested that among chronic pain patients pain ceases to be an icon or an index and acquires a symbolic structure: this transformation interferes with the usual patient-physician relationship. The semiotic perspective on the structure of meaning in the chronic pain(More)
This paper describes Harvard Medical School's integration of a curriculum on health promotion and disease prevention into the first year of its New Pathway to General Medical Education. The goals of the curriculum were to develop in each student (1) the knowledge and skills necessary to evaluate critically the major issues in prevention and (2) an attitude(More)
PROBLEM Health disparities are pervasive worldwide. Physicians have a unique vantage point from which they can observe the ways social, economic, and political factors impact health outcomes and can be effective advocates for enhanced health outcomes and health equity. However, social medicine and health advocacy curricula are uncommon in postgraduate(More)