Abstract：
:Cost-effectiveness analysis and other forms of decision analysis are becoming more common in the medical literature and are increasingly influential in the development of health policy. Nevertheless, many clinicians find it difficult to apply policies developed from these analyses to individual encounters with patients. We examine the assumptions behind these analyses and argue that the perspective they embody can make clinical strategies appear to be less risky in theory than they are at the bedside. We believe that this problem underlies the intuitive concern many physicians have about policy analyses and calls into question the value of these analyses in shaping clinical practice. These analyses aggregate the benefits and burdens of alternative interventions across different individual persons. Thus, overall population risk appears blunted, as it would in a diversified portfolio of stocks that react differently to financial forces or in a herd of cattle that react differently to veterinary interventions. The assumptions behind these analyses make sense if aggregate outcome is what matters, but not if one cares about each individual investment or animal. Because such aggregation tends to understate individual risk, when applied to human health policy, it may misrepresent the interests of patients and cannot be assumed to provide useful guidelines for decision making at the bedside.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Asch DA,Hershey JCdoi
10.7326/0003-4819-122-11-199506010-00007subject
Has Abstractpub_date
1995-06-01 00:00:00pages
846-50issue
11eissn
0003-4819issn
1539-3704journal_volume
122pub_type
杂志文章,评审abstract：STUDY OBJECTIVE:To test the hypothesis that work as a respiratory therapist is associated with an increased risk of developing asthma. DESIGN:Cross-sectional questionnaire study comparing respiratory therapists with controls (physical therapists and radiologic technologists). Subsequent validation of reported asthma w...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-110-10-767
更新日期：1989-05-15 00:00:00
abstract：BACKGROUND:Primary prevention of Alzheimer disease and other types of dementia (all-cause dementia) is an important public health goal. Evidence to date is insufficient to recommend any lifestyle change to prevent or delay the onset of dementia. OBJECTIVE:To assess the association between objectively measured midlife ...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-158-3-201302050-00005
更新日期：2013-02-05 00:00:00
abstract：DESCRIPTION:Updated U.S. Preventive Services Task Force (USPSTF) recommendation about screening for type 2 diabetes mellitus in adults. METHODS:To estimate the balance of benefits and harms of screening, the USPSTF updated its 2003 evidence review, adding evidence from new trials as well as updates on earlier studies....
journal_title：Annals of internal medicine
pub_type： 杂志文章,实务指引
doi：10.7326/0003-4819-148-11-200806030-00007
更新日期：2008-06-03 00:00:00
abstract：BACKGROUND:Longer-term mortality benefit and cost-effectiveness for abdominal aortic aneurysm (AAA) screening are uncertain. OBJECTIVE:To estimate the benefits, in terms of AAA-related and all-cause mortality, and cost-effectiveness of ultrasonography screening for AAA in a group that was invited to screening compared...
journal_title：Annals of internal medicine
pub_type： 杂志文章,多中心研究,随机对照试验
doi：10.7326/0003-4819-146-10-200705150-00003
更新日期：2007-05-15 00:00:00
abstract：DESCRIPTION:Reaffirmation of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for testicular cancer. METHODS:The USPSTF performed a targeted literature search for benefits and harms of screening for testicular cancer in asymptomatic males and found no new studies. RECOMMENDA...
journal_title：Annals of internal medicine
pub_type： 杂志文章,实务指引
doi：10.7326/0003-4819-154-7-201104050-00006
更新日期：2011-04-05 00:00:00
abstract：OBJECTIVE:To determine whether low bone density and other risk factors for osteoporosis are associated with stress fractures in athletes. DESIGN:Case-control study. SETTING:Institutional sports injury clinic with primary and secondary care. PARTICIPANTS:Twenty-five athletes (nineteen women) with scintigraphically co...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-113-10-754
更新日期：1990-11-15 00:00:00
abstract：BACKGROUND:In AIDS, nodular skin disease can result from various causes. OBJECTIVE:To report a new manifestation of microsporidial infection presenting as nodular skin disease with underlying osteomyelitis. DESIGN:Case report. SETTING:Tertiary-care military medical center in Washington, D.C. PATIENT:A 36-year-old w...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-128-11-199806010-00009
更新日期：1998-06-01 00:00:00
abstract：PURPOSE:Cost-utility analysis is a type of cost-effectiveness analysis in which health effects are measured in terms of quality-adjusted life-years (QALYs) gained. Such analyses have become popular for examining the health and economic consequences of health and medical interventions, and they have been recommended by ...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-132-12-200006200-00007
更新日期：2000-06-20 00:00:00
abstract：:The diagnostic and therapeutic value of the angiotensin converting enzyme inhibitor teprotide (SQ 20881) was assessed in 18 patients with hypertensive emergencies. Mean blood pressure fell 31 +/- 18 mm Hg in the 10 subjects who responded to 1 mg/kg body weight administered intravenously, whereas it fell 5 +/- 3 mm Hg ...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-90-1-43
更新日期：1979-01-01 00:00:00
abstract：OBJECTIVE:To assess the use of L-tryptophan by patients with eosinophilic fasciitis and compare this with its use by patients with progressive systemic sclerosis (scleroderma). DESIGN:Retrospective and prospective analysis. Six patients with eosinophilic fasciitis were identified retrospectively and two prospectively....
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-112-10-758
更新日期：1990-05-15 00:00:00
abstract：:The relationship between oral contraceptives and death from thromboembolism shown by studies of vital statistics, and the contribution of cigarette smoking to these deaths are reviewed. In 1968 a British study showed that a slight increase in deaths from thromboembolism had occurred in young women, proportional to th...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：
更新日期：1970-09-01 00:00:00
abstract：STUDY OBJECTIVE:To determine the effect of massive cocaine intoxication on lung water and ascites accumulation and the effect of beta- and alpha-adrenergic blockade on survival in massive cocaine intoxication in the mouse. DESIGN:The effect of massive cocaine intoxication on lung water, ascitic fluid accumulation, and...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-110-3-202
更新日期：1989-02-01 00:00:00
abstract：:Eighty-six patients who required heparin therapy were randomly assigned to receive bovine or porcine heparin. Abnormal concentrations of alanine transaminase and aspartate transaminase developed during treatment in 59.3% and 26.7% of patients, respectively. Patient characteristics that significantly influenced the dev...
journal_title：Annals of internal medicine
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.7326/0003-4819-100-5-646
更新日期：1984-05-01 00:00:00
abstract：STUDY OBJECTIVE:To define the prevalence, severity, type and pathogenesis of osteopenia in idiopathic hemochromatosis. DESIGN:Prospective study conducted over 18 months. SETTING:Tertiary care center. SUBJECTS:Twenty-two men with idiopathic hemochromatosis and 20 age-matched controls. There were 5 hypogonadal patient...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-110-6-430
更新日期：1989-03-15 00:00:00
abstract：:We performed selective venous catheterization and sampling for ACTH in six patients with ACTH-secreting pituitary adenomas (Cushing's disease) and four patients with occult ectopic ACTH-secreting neoplasms. In five patients with Cushing's disease in whom the inferior petrosal sinus could be catheterized, ACTH levels w...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-94-5-647
更新日期：1981-05-01 00:00:00
abstract：BACKGROUND:The established International Prognostic Index for lymphomas has not included patients with systemic AIDS-related non-Hodgkin lymphoma. OBJECTIVE:To establish the most appropriate prognostic index for use in patients with systemic AIDS-related non-Hodgkin lymphoma. DESIGN:A prospective study involving univ...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-143-4-200508160-00007
更新日期：2005-08-16 00:00:00
abstract：:Although the efficacy of hepatitis vaccine is well documented, the duration of immunity of healthy adults after vaccination is unknown. We studied 245 hospital employees 3 years after primary vaccination with hepatitis B vaccine to determine the prevalence of immunity indicated by levels of antibody to hepatitis B sur...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-108-2-185
更新日期：1988-02-01 00:00:00
abstract：:Antinuclear antibodies are present in most patients receiving procainamide. To ascertain whether IgG antiguanosine antibodies are associated with the development of the symptoms of systemic lupus erythematosus, we compared the levels of these antibodies in the sera of 65 patients receiving procainamide: 18 with procai...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-104-3-310
更新日期：1986-03-01 00:00:00
abstract：:We compared the efficacy of orally administered ampicillin, 2 g/d, with that of trimethoprim-sulfamethoxazole, 320 mg/d-1600 mg/d, given for 2 or 6 weeks for outpatient management of acute uncomplicated renal infection in women. Of 98 women participating in the trial, 60 had renal infections with susceptible strains, ...
journal_title：Annals of internal medicine
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.7326/0003-4819-106-3-341
更新日期：1987-03-01 00:00:00
abstract：DESCRIPTION:Update of the 2009 U.S. Preventive Services Task Force (USPSTF) recommendation on counseling and interventions to prevent tobacco use and tobacco-related disease in adults, including pregnant women. METHODS:The USPSTF reviewed the evidence on interventions for tobacco smoking cessation that are relevant to...
journal_title：Annals of internal medicine
pub_type： 杂志文章,实务指引
doi：10.7326/M15-2023
更新日期：2015-10-20 00:00:00
abstract：BACKGROUND:Pay-for-performance (P4P) is increasingly touted as a means to improve health care quality. PURPOSE:To evaluate the effect of P4P remuneration targeting individual health care providers. DATA SOURCES:MEDLINE, EMBASE, Cochrane Library, OpenSIGLE, Canadian Evaluation Society Unpublished Literature Bank, New ...
journal_title：Annals of internal medicine
pub_type： 杂志文章,评审
doi：10.7326/0003-4819-157-12-201212180-00009
更新日期：2012-12-18 00:00:00
abstract：BACKGROUND:The incidence of esophageal adenocarcinoma is increasing rapidly. Gastroesophageal reflux is a strong risk factor for this disease. The increase in incidence of esophageal adenocarcinoma coincided with the introduction of medications that promote reflux by relaxing the lower esophageal sphincter (LES), such ...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-133-3-200008010-00007
更新日期：2000-08-01 00:00:00
abstract：:The usefulness of HbA, as a monitor of metabolic control was studied in 15 diabetic outpatients during periods of stable, deteriorating, and improving control. Mean fasting concentrations of HbA, and plasma glucose during a 3-month period of stable control were 12.6% +/- 0.8% and 120 +/- 8 mg/dL, respectively. One wee...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-92-3-357
更新日期：1980-03-01 00:00:00
abstract：BACKGROUND:Preventive therapy is an important element of syphilis control efforts. No currently recommended, single-dose alternatives to penicillin G benzathine are available for treatment of incubating syphilis. OBJECTIVE:To evaluate the use of a single 1.0-g dose of azithromycin for treatment of persons recently exp...
journal_title：Annals of internal medicine
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.7326/0003-4819-131-6-199909210-00007
更新日期：1999-09-21 00:00:00
abstract：SOURCE CITATION:Liu J, Li L, Li S, et al. Sodium-glucose co-transporter-2 inhibitors and the risk of diabetic ketoacidosis in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2020;22:1619-27. 32364674. ...
journal_title：Annals of internal medicine
pub_type： 评论,杂志文章
doi：10.7326/ACPJ202010200-040
更新日期：2020-10-20 00:00:00
abstract：BACKGROUND:Although some studies suggest that access to cardiac procedures may differ by sex, others have found no evidence of gender bias in cardiac care. OBJECTIVE:To study rates of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery in men and women after cardiac catheterization....
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-136-10-200205210-00007
更新日期：2002-05-21 00:00:00
abstract：:The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during whi...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-150-7-200904070-00115
更新日期：2009-04-07 00:00:00
abstract：BACKGROUND:Progress of diabetes care is a subject of public health concern. OBJECTIVE:To assess changes in quality of diabetes care in the United States by using standardized measures. DESIGN:National population-based, serial cross-sectional surveys. SETTING:National Health and Nutrition Examination Survey (1988-199...
journal_title：Annals of internal medicine
pub_type： 杂志文章
doi：10.7326/0003-4819-144-7-200604040-00005
更新日期：2006-04-04 00:00:00
abstract：:Recently developed radioligand binding techniques permit direct investigation of the alpha- and beta-adrenergic receptors for catecholamines in a wide variety of tissues. These techniques allow the receptors to be quantitated, characterized, and studied under varying conditions of physiologic and pathophysiologic inte...
journal_title：Annals of internal medicine
pub_type： 杂志文章,评审
doi：10.7326/0003-4819-91-3-450
更新日期：1979-09-01 00:00:00
abstract：BACKGROUND:Exercise therapy encompasses a heterogeneous group of interventions. There continues to be uncertainty about the most effective exercise approach in chronic low back pain. PURPOSE:To identify particular exercise intervention characteristics that decrease pain and improve function in adults with nonspecific ...
journal_title：Annals of internal medicine
pub_type： 杂志文章,评审
doi：10.7326/0003-4819-142-9-200505030-00014
更新日期：2005-05-03 00:00:00
