Abstract:
OBJECTIVE:To determine the effectiveness and costs of alternative management strategies for patients infected with the human immunodeficiency virus (HIV) who present with pulmonary symptoms. DESIGN:Decision analysis comparing initial testing (arterial blood gas analysis, induced sputum analysis, or bronchoscopy with bronchoalveolar lavage) with empiric antibiotics (trimethoprim-sulfamethoxazole or erythromycin). Subsequent steps in management are detailed based on the results of initial management. Patients were stratified by initial CD4 lymphocyte count (less than 200/mm3, 200-500/mm3, or greater than 500/mm3) and results of chest radiography. SETTING:Hypothetical. MEASUREMENTS AND MAIN RESULTS:The estimated levels of effectiveness among strategies were relatively similar, but costs varied markedly. If potentially reasonable strategies are defined as those that have incremental cost-effectiveness ratios below $50,000 per quality-adjusted life year (QALY), the recommended strategies would be: for patients at highest risk for Pneumocystis carinii pneumonia (PCP), with a probability of PCP above 30% (CD4 less than 200/mm3 and abnormal chest radiograph or prior history of PCP), begin with induced sputum analysis ($34,174/QALY); for intermediate-risk patients, with a probability of PCP between 6% and 30% (CD4 less than 200/mm3, regardless of chest radiograph; or CD4 200-500/mm3, regardless of chest radiograph findings), begin with arterial blood gas analysis ($4,593 to $8,310/QALY); for low-risk patients, with a probability of PCP below 6% (CD4 greater than 500/mm3, regardless of chest radiograph findings), begin with one week of erythromycin, followed by induced sputum examination if symptoms persist ($675 to $3,306/QALY). For highest-risk patients, if empiric trimethoprim-sulfamethoxazole was considered entirely to be outpatient therapy, it was preferred management if the probability of PCP was above 38%. CONCLUSIONS:The authors conclude that preferred management strategies are determined more by differences in costs than by differences in levels of effectiveness, and that they vary depending on the probability of PCP in definable patient subgroups.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Freedberg KA,Tosteson AN,Cotton DJ,Goldman Ldoi
10.1007/BF02598081subject
Has Abstractpub_date
1992-05-01 00:00:00pages
261-72issue
3eissn
0884-8734issn
1525-1497journal_volume
7pub_type
杂志文章,评审abstract:OBJECTIVE:To compare physicians' and their patients' attitudes toward pharmaceutical gifts. DESIGN:Survey of physicians and their patients. SETTING:Two tertiary-care medical centers, one military and one civilian. PARTICIPANTS:Two hundred sixty-eight of 392 consecutively surveyed physicians, 100 of 103 randomly sele...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1998.00048.x
更新日期:1998-03-01 00:00:00
abstract:BACKGROUND:Treatment decisions about menopause are predicated on a transient duration of vasomotor symptoms. However, evidence supporting a specific duration is weak. OBJECTIVE:To estimate the natural progression of vasomotor symptoms during the menopause transition by systematically compiling available evidence using...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,meta分析
doi:10.1007/s11606-008-0655-4
更新日期:2008-09-01 00:00:00
abstract:BACKGROUND:Perception of body size is a key factor driving health behavior. Mothers directly influence children's nutritional and exercise behaviors. Mothers of ethnic minority groups and lower socioeconomic status are less likely to correctly identify young children as overweight or obese. Little evaluation has been d...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-3002-y
更新日期:2015-01-01 00:00:00
abstract:OBJECTIVES:Among patients unlikely to attend a scheduled colonoscopy, we examined the impact of peer coach versus educational brochure support and compared these with concurrent patients who did not receive support. METHODS:From health system data, we identified 275 consecutive patients aged >50 who kept <75% of visit...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-007-0445-4
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Pregnancy and its impact on graduate medical training are not well understood. OBJECTIVE:To examine the effect of gender and pregnancy for Internal Medicine (IM) residents on evaluations by peers and faculty. DESIGN:This was a retrospective cohort study. SUBJECTS:All IM residents in training from July 1, ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-017-4010-5
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:Individualized selection of antiretroviral (ARV) therapy is complex, considering drug resistance, comorbidities, drug-drug interactions, and other factors. HIV-ASSIST (www.hivassist.com) is a free, online tool that provides ARV decision support. HIV-ASSIST synthesizes patient and virus-specific attributes to...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05531-4
更新日期:2020-05-01 00:00:00
abstract:OBJECTIVE:To determine whether internists in the United States and China have different ideas and behaviors regarding informing patients of terminal diagnoses and HIV/AIDS, the role of the family in end-of-life decision making, and assisted suicide. DESIGN:Structured questionnaire of clinical vignettes followed by mul...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1999.06318.x
更新日期:1999-08-01 00:00:00
abstract:OBJECTIVE:To determine the relevance of the initial certifying examination to the practice of internal medicine and the suitability of items used in initial certification for recertification. DESIGN:Using a matrix-sampling approach, items from the 1991 Certifying Examination were assigned to two sets of judges: direct...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599989
更新日期:1993-02-01 00:00:00
abstract:BACKGROUND:Patient navigator (PN) programs can improve breast cancer screening in low income, ethnic/racial minorities. Refugee women have low breast cancer screening rates, but it has not been shown that PN is similarly effective. OBJECTIVE:Evaluate whether a PN program for refugee women decreases disparities in brea...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-013-2491-4
更新日期:2013-11-01 00:00:00
abstract:INTRODUCTION:Although women will account for almost 11% of veterans by 2040, we know little about their health and functioning, particularly compared to men. OBJECTIVE:To compare women and men veterans' health-related quality of life (HRQOL) and VA health care utilization and to see if previously described association...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-007-0254-9
更新日期:2007-09-01 00:00:00
abstract:BACKGROUND:Attending physicians are well positioned to identify medical errors and understand their consequences. The spectrum of errors that can be detected by attending physicians in the course of their usual practice is currently unknown. OBJECTIVES:To determine the frequency, types, and consequences of errors that...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2003.20919.x
更新日期:2003-08-01 00:00:00
abstract::To assess attitudes toward educational programs about AIDS, 540 patients and 36 of their medical providers in primary care clinics were systematically sampled to ascertain what age groups should be exposed to a pamphlet entitled "Am I at Risk for AIDS?", as well as what was acceptable content for posters and pamphlets...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02596487
更新日期:1989-01-01 00:00:00
abstract:BACKGROUND:Lack of regular physical activity is highly prevalent in U.S. adults and significantly increases mortality risk. OBJECTIVE:To examine the clinical impact of a newly implemented program ("Exercise as a Vital Sign" [EVS]) designed to systematically ascertain patient-reported exercise levels at the beginning o...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-013-2693-9
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:National guidelines make recommendations regarding the initial opioid prescriptions, but most of the supporting evidence is from the initial episode of care, not the first prescription. OBJECTIVE:To examine associations between features of the first opioid prescription and high-risk opioid use in the 18 mon...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4628-y
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:Residency programs involve trainees in quality improvement (QI) projects to evaluate competency in systems-based practice and practice-based learning and improvement. Valid approaches to assess QI proposals are lacking. OBJECTIVE:We developed an instrument for assessing resident QI proposals--the Quality Im...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0260-y
更新日期:2007-09-01 00:00:00
abstract:BACKGROUND:Domestic violence (DV) is prevalent across all racial and socioeconomic classes in the United States. Little is known about whether physicians differentially screen based on a patient's race or socioeconomic status (SES) or about resident physician screening attitudes and practices. OBJECTIVE:To assess the ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00494.x
更新日期:2006-09-01 00:00:00
abstract:BACKGROUND:Little is known about how primary care clinicians (PCCs) approach chronic pain management in the current climate of rapidly changing guidelines and the growing body of research about risks and benefits of opioid therapy. OBJECTIVE:To better understand PCCs' approaches to managing patients with chronic pain ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06178-2
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Maintenance of certification examination performance is associated with quality of care. We aimed to examine relationships between electronic medical knowledge resource use, practice characteristics and examination scores among physicians recertifying in internal medicine. METHODS:We conducted a cross-secti...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-012-2017-5
更新日期:2012-08-01 00:00:00
abstract:BACKGROUND:Prevalence of unhealthy alcohol use among medical inpatients is high. OBJECTIVE:To characterize the course and outcomes of unhealthy alcohol use, and factors associated with these outcomes. DESIGN:Prospective cohort study. PARTICIPANTS:A total of 287 medical inpatients with unhealthy alcohol use. MAIN ME...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1382-1
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVES:To evaluate the comparative effectiveness of antiviral drugs in adults with chronic hepatitis B monoinfection for evidence-based decision-making. METHODS:A systematic review of randomized controlled clinical trials (RCTs) published in English. Results after interferon and nucleos(t)ides analog therapies wer...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-010-1569-5
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:The health and healthcare of sexual minorities have recently been identified as priorities for health research and policy. OBJECTIVE:To compare the health and healthcare experiences of sexual minorities with heterosexual people of the same gender, adjusting for age, race/ethnicity, and socioeconomic status....
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-2905-y
更新日期:2015-01-01 00:00:00
abstract:OBJECTIVE:To describe a novel method of time analysis for health care settings by quantifying internal medicine housestaff's work activities and contacts. DESIGN:Observational work sampling study based on random sampling technique. SETTING:General medicine service in a university hospital. PARTICIPANTS:All housestaf...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599655
更新日期:1994-05-01 00:00:00
abstract:OBJECTIVE:Adherence to combination antiretroviral therapy is critical for clinical and virologic success in HIV-infected patients. To combat poor adherence, clinicians must identify nonadherent patients so they can implement interventions. However, little is known about the accuracy of these assessments. We sought to d...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2002.09004.x
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:Patients are often treated in hospital by physicians other than their regular community doctor. After they are discharged, their care is often returned to their regular community doctor and patients may not see the hospital physician. Transfer of information between physicians can be poor. We determined whet...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.30082.x
更新日期:2004-06-01 00:00:00
abstract:OBJECTIVE:To examine the impact of a nurse-coordinated intervention delivered to patients with non-insulin-dependent diabetes mellitus between office visits to primary care physicians. DESIGN:Randomized, controlled trial. SETTING:Veterans Affairs general medical clinic. PATIENTS:275 veterans who had NIDDM and were r...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/BF02600227
更新日期:1995-02-01 00:00:00
abstract:BACKGROUND:Global health measures represent an attractive option for researchers and clinicians seeking a brief snapshot of a patient's overall perspective on his or her health. Because scores on different global health measures are not comparable, comparative effectiveness research (CER) is challenging. OBJECTIVE:To ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-015-3453-9
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:Although hip fractures in older adults are associated with a high degree of mortality and disability, the use of advance care planning (ACP) in this population is unknown. OBJECTIVE:To determine the prevalence of ACP and need for surrogate decision-making prior to death in older adults with hip fracture and...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-05644-1
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:Pay-for-performance (P4P) has been used expansively to improve quality of care delivered by physicians. However, to what extent P4P works through the provision of information versus financial incentives is poorly understood. OBJECTIVE:To determine whether an increase in information feedback without changes ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05004-8
更新日期:2019-09-01 00:00:00
abstract:PURPOSE:To evaluate the acceptance rate and motivation for acceptance of hepatitis B virus (HBV) vaccine among preclinical medical and physician assistant (PA) students in comparison with similar data obtained from resident and staff physicians. METHODS:A cross-sectional survey of all second-year medical and PA studen...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599567
更新日期:1995-01-01 00:00:00
abstract:BACKGROUND:Many medical schools have incorporated the Stages of Change Model into their curricula with specific application to tobacco cessation. OBJECTIVE:This study examined the extent to which medical students were prepared to provide stage-based interventions to treat nicotine dependence. DESIGN:Using a quasi-exp...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-006-0040-0
更新日期:2007-02-01 00:00:00