Abstract:
OBJECTIVE:To compare the efficacies and cost-effectiveness of four strategies for the management of suspected pedal osteomyelitis in the setting of vascular impairment: 1) therapeutic trial of short-term antibiotics for presumed cellulitis without osteomyelitis (short); 2) technetium bone scanning followed by either short-term therapy if negative or either a biopsy or aggressive long-term intravenous therapy if positive (scan); 3) bone biopsy followed by long-term intravenous therapy if positive or short-term therapy if negative (biopsy); and 4) immediate long-term intravenous antibiotics for presumed osteomyelitis (long). DESIGN:Decision analysis and cost-effectiveness analysis with sensitivity analyses. The main outcomes states are amputation and the resource expenditures associated with bone scans, biopsies, and therapies. DATA SOURCES:The authors obtained estimates of test accuracy from literature review and summarized them using newly developed meta-analytic techniques. MAIN RESULTS:The optimal decision depends heavily on the estimated probability of osteomyelitis at presentation. At very low probabilities, the short-term strategy is preferred. When the probability of osteomyelitis is from 2% to 8%, the lowest amputation rate occurs when one does a diagnostic scan. From 8% to 50%, the best outcomes follow biopsy. At probabilities higher than 50%, the preferred strategy is long-term antibiotics. However, the differences in outcomes are quite small even when osteomyelitis is a virtual certainty. CONCLUSIONS:Over the whole range of prior probabilities, the short-term strategy is the least expensive. At very low probabilities, it dominates the other strategies. When the likelihood of osteomyelitis is higher (10-20%), scanning results in outcomes and cost-effectiveness ratios comparable to those of immediate biopsy and is less invasive. When the probability of osteomyelitis is 50%, biopsy is quite cost-effective compared with all the other strategies (cost-effectiveness ratio = $15,502 per amputation averted) and is preferred to the scan strategy. When the confidence that a patient has osteomyelitis is very high (> 90% probability), the improved outcomes associated with long-term antibiotics are achieved with little additional expense and with favorable cost-effectiveness ratios compared with those of the other strategies.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Mushlin AI,Littenberg Bdoi
10.1007/BF02599133subject
Has Abstractpub_date
1994-01-01 00:00:00pages
1-7issue
1eissn
0884-8734issn
1525-1497journal_volume
9pub_type
杂志文章abstract::The objective of this study was to assess reasons for physicians' noncompliance with computer-generated preventive care reminders. In an academic general internal medicine practice, a survey of physicians' reasons for noncompliance found that 55% of reminders were not complied with. Reasons included "not applicable" i...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599049
更新日期:1996-08-01 00:00:00
abstract:OBJECTIVE:Routine screening for prostate cancer is controversial because of frequent false-positive results, the potential for slow, non-life-threatening growth of untreated cancer, the uncertainty regarding whether treatment can extend life, and the potential for treatment complications. This study examines how inform...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章
doi:10.1007/BF02600045
更新日期:1996-06-01 00:00:00
abstract:BACKGROUND:Previous studies indicate that medical trainees frequently experience discrimination by patients. Little is known about effective strategies to teach trainees to respond to this discrimination. AIM:To create a workshop for first-year residents utilizing standardized patients to improve skills in responding ...
journal_title:Journal of general internal medicine
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更新日期:2019-05-01 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
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doi:10.1007/BF02596487
更新日期:1989-01-01 00:00:00
abstract:OBJECTIVE:To determine the frequency with which an acute confusional state is caused by a stroke and to evaluate the usefulness of obtaining computed tomography scans in this setting. DESIGN:Retrospective analysis. SETTING:Tertiary referral center. PATIENTS:The authors reviewed 127 neurology consultations requested ...
journal_title:Journal of general internal medicine
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更新日期:1994-09-01 00:00:00
abstract::Community health centers (CHCs) provide primary care for underserved children and adults. The Patient Protection and Affordable Care Act (ACA) aimed to strengthen the CHC network by increasing federal funds and expanding Medicaid eligibility. The ACA also aimed to boost preventive and mental health services and to red...
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journal_title:Journal of general internal medicine
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更新日期:1997-01-01 00:00:00
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更新日期:2010-10-01 00:00:00
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更新日期:2010-01-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:1995-07-01 00:00:00
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更新日期:2000-09-01 00:00:00
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更新日期:1999-08-01 00:00:00
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更新日期:2008-07-01 00:00:00
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更新日期:2013-07-01 00:00:00
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