Abstract:
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.
journal_name
South Med Jjournal_title
Southern medical journalauthors
Le HH,DeCamp M,Bertram A,Kale M,Berger Zdoi
10.14423/SMJ.0000000000000901subject
Has Abstractpub_date
2018-12-01 00:00:00pages
758-762issue
12eissn
0038-4348issn
1541-8243pii
SMJ50633journal_volume
111pub_type
杂志文章abstract::We present information describing how to search to identify those reports that provide insight into the answer to the query. We have presented a reasonable approach to searching, with our end-point being the identification of published articles which appear to answer our queries. The decision as to whether these artic...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/SMJ.0b013e31824a711f
更新日期:2012-03-01 00:00:00
abstract::The percutaneous subclavian vein hemodialysis catheter, which is widely used for vascular access in patients with renal failure, can give rise to several complications. Asymptomatic stenosis or occlusion of the subclavian vein due to these catheters can lead to painful arm edema if further dialysis accesses are constr...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198803000-00004
更新日期:1988-03-01 00:00:00
abstract::Pyridium (phenazopyridine hydrochloride) is often prescribed as an analgesic in patients following trauma, surgery, or infections of the urinary tract. Pyridium toxicity has been previously reported, however, most cases result in a single adverse effect. Herein the authors describe an elderly patient who presented wit...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.smj.0000197299.77949.16
更新日期:2006-01-01 00:00:00
abstract::The right ventricle is not normally displayed by studies with thallium 201 in patients at rest, but it can be shown by thallium 201 myocardial scintigraphy with pressure or volume overload of the right ventricle and with right ventricular hypertrophy. We sought to determine the frequency of right ventricular demonstra...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198512000-00009
更新日期:1985-12-01 00:00:00
abstract:BACKGROUND:Echocardiographic demonstration of valvular infection now ranks with positive blood cultures as one of the two major clinical criteria for diagnosis of infective endocarditis (IE), according to new, more accurate guidelines for diagnosis. Because early detection of IE and its complications is essential for d...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:
更新日期:1999-08-01 00:00:00
abstract::Described is a surgical procedure for pes cavus which includes multiple osteotomies of the metatarsals, usually combined with Steindler fasciotomy and extensor tenotomy. This method permits the correction of the cavus deformity and preserves the length of the foot without disturbing any joint. A total of 11 patients w...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197701000-00034
更新日期:1977-01-01 00:00:00
abstract::To show the usefulness of the Society of Thoracic Surgeons (STS) National Database in providing clinical and cost-related outcome data, we studied 297 consecutive patients who had isolated coronary artery bypass grafting (CABG) and who were assigned to either a "fast track" or traditional track. The observed overall m...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199611000-00009
更新日期:1996-11-01 00:00:00
abstract::In a retrospective review from 1987 to 1989, we identified seven alcoholics who had severe acute hepatocellular injury soon after using acetaminophen for therapeutic purposes and who had no suicidal intent. All had markedly elevated serum transaminase values (aspartate aminotransferase greater than 4000 U/L) and prolo...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199009000-00017
更新日期:1990-09-01 00:00:00
abstract:BACKGROUND:Mortality rates for hyperthermia and hypothermia are higher in Alabama than nationally, and Alabama has twice as many hypothermia deaths as hyperthermia deaths. These causes of death have not been studied in the southeastern United States. We describe the epidemiology of heat- and cold-related deaths in Alab...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:2000-08-01 00:00:00
abstract::Nodular fasciitis is a benign proliferation of fibroblasts and myofibroblasts in the subcutaneous tissues. The lesions are generally small and solitary, arising commonly in the upper extremities of adults and in the head and neck region of infants and children. A history of trauma may precede these reactive lesions, b...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-199408000-00020
更新日期:1994-08-01 00:00:00
abstract::The modern, comprehensive care of patients with hemophilia requires an awareness that complications other than those caused by acute hemorrhage can occur. The use of newer, more potent plasma concentrates has been accompanied by an increased incidence of liver disease in transfusion-requiring hemophiliacs. The progres...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-198002000-00011
更新日期:1980-02-01 00:00:00
abstract::Malignant catatonia is a severe form of catatonia which is acute in onset, and is systemically devastating, as it is associated with fever and autonomic instability. Although rarely described in children and adolescents, malignant catatonia should feature prominently in the differential diagnosis of acute pediatric en...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0b013e3181b9e39c
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND:Ventilator-associated pneumonia (VAP) is one of the most frequent infections in intensive care units (ICUs), and nearly 50% of patients with VAP develop septic shock. Septic shock is an independent predictor for mortality in these patients. OBJECTIVE:To investigate the predictors for septic shock in VAP pat...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0b013e3181827891
更新日期:2008-12-01 00:00:00
abstract::Cronkhite-Canada syndrome is a rare, noninherited gastrointestinal polyposis syndrome associated with characteristic ectodermal abnormalities. This report describes a 60-year-old female who was diagnosed with Cronkhite-Canada syndrome with hypothyroidism after presenting with chronic diarrhea, alopecia, intermittent a...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.SMJ.0000157528.71614.C4
更新日期:2005-05-01 00:00:00
abstract::Intravesical BCG (bacillus Calmette-Guérin) instillation is a first-line treatment for superficial transitional cell carcinoma of the bladder. A rare but severe complication of BCG immunotherapy is the development of disseminated BCG disease, which can result in miliary pneumonitis, granulomatous hepatitis, soft tissu...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0b013e31815d4047
更新日期:2008-01-01 00:00:00
abstract::Aspergilloma is a common complication of cystic lung disease; it is widely considered to be a saprophytic colonization and local or disseminated invasion is unusual. We describe a patient with stage IV sarcoidosis and bilateral aspergillomas in whom locally invasive disease led to spinal cord compression. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198405000-00028
更新日期:1984-05-01 00:00:00
abstract::Elevation in fasting serum gastrin levels was found in three patients being evaluated for persistent upper abdominal pain without radiographic evidence of peptic ulcer disease. Fiberoptic endoscopy of the upper gastrointestinal tract in each patient revealed characteristic changes of chronic atrophic gastritis. Gastri...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197612000-00010
更新日期:1976-12-01 00:00:00
abstract::We have described a patient with a biopsy-proven mucoepidermoid carcinoma of the orbit. Although it may have represented a metastasis from a malignancy of the upper respiratory tract, clinically it appeared to be a primary neoplasm of the lacrimal gland. This case emphasizes the value of transmission electron microsco...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198905000-00027
更新日期:1989-05-01 00:00:00
abstract::We reviewed the charts of 106 patients treated with carbamazepine. Age, sex, race, seizure type, seizure focus, age at onset, duration of epileptic illness, reasons for discontinuing treatment, other medications, and response to treatment of seizures, psychiatric symptoms, and behavioral symptoms were recorded. Statis...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199301000-00005
更新日期:1993-01-01 00:00:00
abstract::Tobacco use is associated with numerous illnesses and contributes to as many as 400,000 deaths in the United States each year. Most tobacco use in the United States is in the form of cigarette smoking, but smokeless tobacco use is particularly high in certain areas and within certain subpopulations. Among US adults, s...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2000-05-01 00:00:00
abstract::Pulmonary involvement with non-Hodgkin's lymphoma, while well recognized, is less common than with Hodgkin's lymphoma. Endobronchial non-Hodgkin's lymphoma is even rarer and usually occurs in the presence of disseminated disease. We present a case of bilateral endobronchial non-Hodgkin's lymphoma. ...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-199503000-00025
更新日期:1995-03-01 00:00:00
abstract::The transition of care between pediatric and adult medicine is a challenging time for patients and physicians. This longitudinal process encompasses much more than the physical transfer of a patient between providers. Established transition of care processes and literature exist for many chronic disease populations, b...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.14423/SMJ.0000000000001017
更新日期:2019-09-01 00:00:00
abstract::This article documents distributional patterns of allopathic family practice physicians (including general practitioners) in Texas as compared with allopathic physicians in all other medical specialties in the state during the period 1969-1973, for which there are reliable data. Statistical analysis of this informatio...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197709000-00007
更新日期:1977-09-01 00:00:00
abstract::A survey of death certificates of victims with laryngeal cancer in Oklahoma for the period 1950 to 1970 attempts to corroborate findings of the current literature. Sex-race specific death rates per 100,000 for white, nonwhite, and American Indian populaces displayed a distinct sex and racial pattern: respectively, 38....
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197607000-00033
更新日期:1976-07-01 00:00:00
abstract::When patient records are to be auditied in a program designed to assess the quality of medical care rendered, careful consideration must be given to the cost of the system implemented. Structured data collection and a defined treatment plan are advantageous in facilitating the use of nonphysicians for the majority of ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197610000-00022
更新日期:1976-10-01 00:00:00
abstract:OBJECTIVES:To characterize pain and exposure after Prolift placement and identify risk factors. METHODS:A case series of women who underwent Prolift vaginal mesh were surveyed. Pain was assessed using a visual analog scale. Exposure was evaluated clinically. RESULTS:Of 183 eligible patients, 160 completed the survey,...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.14423/SMJ.0000000000000377
更新日期:2015-12-01 00:00:00
abstract:OBJECTIVE:To compare mobile health (mHealth) usage by residents of West Virginia with national estimates. METHODS:Pew Research Center data from its Internet and American Life Project were accessed for secondary data analysis. These data, available to the public, are a probability sample of Internet use in the United S...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.14423/SMJ.0000000000000879
更新日期:2018-10-01 00:00:00
abstract::With the epidemic of cholera in South and Central America and reports of cholera in the Northern Hemisphere in Mexico, increasing concern focuses on sanitation problems along the border between the United States and Mexico. It is feared that binationally shared water supplies are threatened or contaminated by sewage a...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199211000-00003
更新日期:1992-11-01 00:00:00
abstract::Axillary and palmar hyperhidrosis are featured prominently in the literature, but no previous studies have detailed a treatment regimen for specific excessive localized sweating of the face and scalp. In this report, a patient was treated for this condition with a combination of clonidine hydrochloride (0.3 mg to 0.4 ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:2000-01-01 00:00:00
abstract::Subdural hematomas are among the most common forms of intracranial hemorrhage encountered in clinical practice and are a surgically remediable cause of dementia. When the symptom presentation is subtle or diffuse, a subdural hematoma can be overlooked. This is especially true among elderly people who may exhibit unrel...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199509000-00019
更新日期:1995-09-01 00:00:00