Influences on Primary Care Provider Imaging for a Hypothetical Patient with Low Back Pain.


OBJECTIVE:How outside factors affect physician decision making remains an open question of vital importance. We sought to investigate the importance of various influences on physician decision making when clinical guidelines differ from patient preference. METHODS:An online survey asking 469 primary care providers (PCPs) across four practice sites whether they would order magnetic resonance imaging for a patient with uncomplicated back pain. Participants were randomized to one of four scenarios: a patient's preference for imaging (control), a patient's preference plus a colleague's opinion against imaging (colleague), a patient's preference plus a professional society's recommendation against imaging (profession), or a patient's preference plus an accountable care organization's quality metric that measures physician use of imaging (ACO). Demographic information and the reasoning behind participants' decisions also were obtained. RESULTS:A total of 168 PCPs completed the survey, yielding a 36% completion rate. A majority chose not to pursue imaging: control 68%, colleague 85%, profession 87%, and ACO 78%. Multivariate logistic regression revealed that participants were more likely not to order advanced imaging only when reminded of a professional society recommendation (P = 0.017). Regression also suggested that practice site exerted an effect on the primary outcome. Evidence-based medicine and clinical judgment were the most cited reasons for the decision. CONCLUSIONS:Our results reinforce the potential to leverage professional societies to advance evidence-based medicine and reduce unnecessary testing. At the same time, practice site appeared to exert influence, suggesting that these recommendations must be part of local institutional culture to be effective.


South Med J


Southern medical journal


Le HH,DeCamp M,Bertram A,Kale M,Berger Z




Has Abstract


2018-12-01 00:00:00














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    abstract::I have reported three case of paraurethral cysts in female neonates. These are uncommon lesions, and urologic evaluation is required to differentiate them from ectopic ureteroceles, urethral diverticula, or paraurethral tumors. Histologic appearance of the cyst epithelium identifies the embryologic origin. The cysts e...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Bergner DM

    更新日期:1985-06-01 00:00:00

  • Metastatic prostatic carcinoma presenting as fulminant hepatic failure.

    abstract::A 68-year-old male presented with progressive abdominal pain, dyspnea, weight loss, and dysuria. Lab work revealed elevated creatine phosphokinase levels, prostate-specific antigen level (approximately 60 ng/mL), and elevated liver enzymes. He was admitted to the intensive care unit for worsening respiratory distress ...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Shakir FA,Madhoun M,Whorton J,Harty R

    更新日期:2008-10-01 00:00:00

  • Exercise training and prescription for the elderly.

    abstract::Most exercise programs designed for healthy persons older than 65 emphasize fitness development, but the maintenance of functional capacity and quality of life are equally important. The basic guidelines for frequency, intensity, and duration of training and the mode of activity recommended by the American College of ...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Pollock ML,Graves JE,Swart DL,Lowenthal DT

    更新日期:1994-05-01 00:00:00

  • Treatment of keloids by single intraoperative perilesional injection of repository steroid.

    abstract::Keloid management remains controversial, and recurrence and untoward side effects limit the use of many techniques. During a seven-year period, I surgically treated 19 children, aged 3 to 17 (mean 10.5 years), with a total of 28 keloids. After aseptic skin preparation, the interface between the keloid and normal skin ...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Golladay ES

    更新日期:1988-06-01 00:00:00

  • Vulvovaginitis in prepubertal girls: the importance of group A Streptococcus.

    abstract::We report four cases of group A streptococcal vulvovaginitis in prepubertal children. All cases were acute in onset. This illness presents with nonspecific signs and symptoms of labial inflammation. In a suburban community, streptococcal vulvovaginitis in prepubescent girls may be more common then genital infections d...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Schwartz RH,Wientzen RL,Barsanti RG

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    abstract::Blastomycosis in children is relatively infrequent. Further, osteomyelitis of the frontal bone, which prior to the antibiotic era occurred more frequently and was mostly due to pyogenic cocci, is rare today. We described a case of frontal osteomyelitis in a child due to blastomycosis which occurred in the absence of f...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Devgan BK,Devgan M,Gross CW

    更新日期:1978-02-01 00:00:00

  • Unilateral adrenal mass due to Mycobacterium kansasii in an AIDS patient.

    abstract::Infection with Mycobacterium kansasii in patients with acquired immunodeficiency syndrome usually involves the lung or disseminated infection. We report a case of infection with M kansasii confined to the adrenal gland and possibly to an adjacent vertebral body that presented as a fever of undetermined origin. ...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Cook PP,Christie J

    更新日期:1998-10-01 00:00:00

  • Nerve root cut-off on metrizamide-enhanced computerized tomography.

    abstract::The "wink" sign of nerve root cut-off seen on metrizamide-enhanced computerized tomography correlates well with compression of a lumbar nerve by a herniated disk. Seven of 46 patients had normal or equivocal myelograms, but had definite nerve root cut-off on metrizamide-enhanced CT scan. All seven patients were found ...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Smith GR

    更新日期:1986-05-01 00:00:00

  • Perforation of the small bowel with rheumatoid arthritis.

    abstract::Mesenteric occlusion is a rare and usually fatal complication of rheumatoid arthritis (RA). We report a patient with RA who had an acute condition of the abdomen, with clinical evidence of perforated bowel confirmed by histologic study. The successful result in this case is attributed to early surgical intervention. A...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Tsai JT

    更新日期:1980-07-01 00:00:00

  • Preparation of tables for medical articles: guidelines for physician-authors.

    abstract::This review of the basic purposes and principles of tables is oriented toward their preparation by physician-authors for use in medical manuscripts. The guidelines suggested are consistent with the general format and style current in scientific and medical writing, with emphasis upon the latter. Style and usage do evo...

    journal_title:Southern medical journal

    pub_type: 杂志文章



    更新日期:1976-12-01 00:00:00

  • Megaloblastic anemia in a vegetarian taking oral contraceptives.

    abstract::A case is reported of megaloblastic anemia resulting from folate deficiency in a vegetarian who had been taking oral contraceptives for eight years. A brief report of the pertinent literature is included, ...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Green JD

    更新日期:1975-02-01 00:00:00

  • Review of 333 living donor nephrectomies.

    abstract::We reviewed the operative complications in 333 living related donor nephrectomies done at our institution over the past 12 years. The overall complication rate was 17.1%; only three patients (0.9%) had major complications, and none died. The major complications were a delayed splenectomy because of bleeding, an adrena...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Ottelin MC,Bueschen AJ,Lloyd LK,Joseph DB,Diethelm AG,Burns JR

    更新日期:1994-01-01 00:00:00

  • Cognitive Behavioral Therapy in the Treatment of Insomnia.

    abstract::Insomnia disorder is present in as much as 30% of the general adult population. Given the significant adverse effects of pharmacotherapy, cognitive behavioral therapy (CBT) has been found to be an effective alternative in individuals with insomnia. CBT for insomnia (CBTi) encompasses sleep hygiene, stimulus control, s...

    journal_title:Southern medical journal

    pub_type: 杂志文章,评审


    authors: Haynes J,Talbert M,Fox S,Close E

    更新日期:2018-02-01 00:00:00

  • Glycerol: an alternative to dexamethasone for patients receiving brain irradiation for metastatic disease.

    abstract::Forty-four patients with metastatic brain neoplasms received glycerol instead of corticosteroids during periods of brain irradiation. Headache, nausea, and vomiting were controlled in more than 90% of symptomatic patients, while paralysis, confusion, and papilledema improved in 55% to 80%. Patients with minimal or no ...

    journal_title:Southern medical journal

    pub_type: 临床试验,杂志文章


    authors: Bedikian AY,Valdivieso M,Heilbrun LK,Withers RH,Bodey GP,Freireich EJ

    更新日期:1980-09-01 00:00:00

  • Fatal pulmonary embolism in cancer patients: is heparin prophylaxis justified?

    abstract::The incidence of fatal and nonfatal pulmonary embolism (PE) was evaluated in a series of 578 patients, to quantify the suspected higher risk in cancer patients of death from massive PE when compared with patients not having cancer. PE occurred in 13% and was fatal in 8% of noncancer patients. It occurred in 17% and wa...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Shen VS,Pollak EW

    更新日期:1980-07-01 00:00:00

  • Leiomyosarcoma of the Cervix Uteri.

    abstract::We have described a 38-year-old woman with a lesion of the cervix found on routine physical examination. The lesion proved to be a primary leiomyosarcoma of the cervix. Despite radiation therapy, surgery, and chemotherapy, the tumor recurred and grew relentlessly. She is alive with disease at two years seven months af...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Jawalekar KS,Zacharopoulou M,McCaffrey RM

    更新日期:1981-04-01 00:00:00

  • Nodular sclerosing Hodgkin's disease presenting as nephrotic syndrome.

    abstract::A case of nephrotic syndrome due to minimal change renal disease was associated with minimally symptomatic nodular sclerosing Hodgkin's disease in a 15-year-old girl. Although minimal renal disease is the most frequently described biopsy finding in this paraneoplastic syndrome, the combination of nodular sclerosing Ho...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Cale WF,Ullrich IH,Jenkins JJ

    更新日期:1982-05-01 00:00:00

  • Placenta increta occurring in a blighted ovum.

    abstract::We present a rare case of placenta increta, confirmed postoperatively by pathologic analysis, occurring before 20 weeks' gestation in a blighted ovum. Hysterectomy was necessary for control of hemorrhage. ...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Gist RS,Vuong V,Brody S,Rees P,Landry AD

    更新日期:1996-05-01 00:00:00

  • Videoscopically assisted fascia lata harvest for the correction of recurrent ventral hernia.

    abstract::Autologous fascia lata tissue transfer is a feasible alternative to reconstruction of the abdominal wall in selected patients. We describe a new technique using minimally invasive technology that allows harvest of the fascia lata graft without the traditional large thigh incision. ...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Tucker JG,Choat D,Zubowicz VN

    更新日期:1997-04-01 00:00:00

  • Factors Influencing Injury Severity of Bicyclists Involved in Crashes with Motor Vehicles: Bike Lanes, Alcohol, Lighting, Speed, and Helmet Use.

    abstract:OBJECTIVES:In 2014, 726 bicyclists were killed and an additional 50,000 were injured in crashes with motor vehicles. The number of cyclists in the United States is increasing, and as a result there has been a call for more bike lanes. We examined the difference in the severity of injury of bicyclists involved in motor ...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Helak K,Jehle D,McNabb D,Battisti A,Sanford S,Lark MC

    更新日期:2017-07-01 00:00:00

  • Giant cell arteritis in a black patient.

    abstract::Giant cell arteritis has been thought to occur only in white patients. There have been several recent reports of this disorder to blacks, however, and this case of biopsy-proven giant cell arteritis in a black patient indicates the diagnosis should be considered in any elderly patient with typical symptoms regardless ...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Wilson JW,Topolosky MK,Hettleman BD,Bredehoeft SJ

    更新日期:1979-09-01 00:00:00

  • Electrical injuries.

    abstract::Electrical injuries may occur from high or low voltage contact. Low voltage injuries usually occur in the home, tetany may lead to sustained contact, and dangerous cardiac disturbances often result. High voltage injuries are usually work related and result from brief contact but may cause serious tissue destruction an...

    journal_title:Southern medical journal

    pub_type: 杂志文章,评审


    authors: Martinez JA,Nguyen T

    更新日期:2000-12-01 00:00:00

  • A resurgence of acute rheumatic fever in a mid-South children's hospital.

    abstract::A resurgence of acute rheumatic fever (ARF) has been reported in many areas of the United States in recent years. We retrospectively reviewed the medical records of inpatients with a new diagnosis of ARF from 1982 through 1988 at a children's hospital that serves a six-state referral area in the mid-South. Thirty pati...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Leggiadro RJ,Birnbaum SE,Chase NA,Myers LK

    更新日期:1990-12-01 00:00:00

  • Oxidative stress in diabetic macrovascular disease: does homocysteine play a role?

    abstract:BACKGROUND:Non-insulin-dependent diabetes mellitus (NIDDM) and hyperhomocysteinemia are both associated with increased lipid peroxidation (oxidative stress). This may contribute to the accelerated vascular disease associated with these conditions. It is not known whether the coexistence of elevated homocysteine levels ...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Fonseca VA,Stone A,Munshi M,Baliga BS,Aljada A,Thusu K,Fink L,Dandona P

    更新日期:1997-09-01 00:00:00

  • Malignant secondary parotid tumors.

    abstract::Malignant secondary parotid neoplasms are uncommon. Among 545 malignant parotid tumors, we found 52 (9%) that did not arise primarily in the parotid gland. Lymphomas or tumors of hematopoietic origin were excluded from this study. All patients had a parotid mass (two bilateral), one third of which were painful; 20% ha...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Rees R,Maples M,Lynch JB,Rosenfeld L

    更新日期:1981-09-01 00:00:00

  • Menetrier's disease in children.

    abstract::Two new cases of Menetrier's disease in children are reported. The ten cases of this protein-losing gastropathy previously reported in the literature are reviewed. Clinical presentations, laboratory findings, possible causes, and comparison with the adult form of Menetrier's disease are discussed. Menetrier's disease ...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Kadlec G,Goodwin R,Fellows R,Andrews B

    更新日期:1979-01-01 00:00:00

  • Cerebrospinal rhinorrhea: diagnosis and management.

    abstract::The role of the otolaryngologist in the diagnosis and management of cerebrospinal fluid rhinorrhea is discussed. One hundred eight cases of cerebrospinal rhinorrhea were studied with emphasis on cause, localization, and treatment. Extracranial approaches produce minimal morbidity and should be considered as possible t...

    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Hudson WR,Hughes LA

    更新日期:1975-12-01 00:00:00

  • Evaluation and management of shoulder pain in primary care clinics.

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    journal_title:Southern medical journal

    pub_type: 杂志文章,评审


    authors: House J,Mooradian A

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  • Eradication Rate of Helicobacter pylori on the US-Mexico Border Using the Urea Breath Test.

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    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: Liu RP,Romero R,Sarosiek J,Dodoo C,Dwivedi AK,Zuckerman MJ

    更新日期:2018-01-01 00:00:00

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    journal_title:Southern medical journal

    pub_type: 杂志文章


    authors: DiClemente RJ,Funkhouser E,Wingood G,Fawal H,Holmberg SD,Vermund SH

    更新日期:2002-04-01 00:00:00