Abstract：
OBJECTIVE:To determine whether the addition of Quick Medical Reference (QMR) to usual educational tools improves an intern's performance in managing clinical cases that test diagnostic and investigative skills. DESIGN:Randomized, controlled, single-blinded crossover study. SETTING:Tertiary care teaching hospital. SUBJECTS:Comprehensive medical interns who are proficient in the use of QMR. INTERVENTION:A total of 16 interns trained in the use of QMR were randomized to work up a total of six diagnostically challenging cases, three using medical textbooks plus access to QMR and three using textbooks and no access to QMR. MEASUREMENTS:The interns provided their solutions to the cases, which consisted of the differential diagnosis and investigations. They were scored by comparing their answers with the consensus answers provided by subspecialty consultants. For each intern, the difference in mean total scores with and without QMR was calculated. RESULTS:The mean difference in total scores was 7.2% benefit (p < 0.05, 95% CI = 0.05 to 14.4) using QMR. The beneficial difference was driven mainly by improvement in diagnostic scores, with the mean difference being 11.6% (p = 0.01, 95% CI = 2.4 to 20.8). Regression analysis showed that the more difficult the case, the greater the benefit of QMR. CONCLUSIONS:Quick Medical Reference may be a useful adjunct to interns in formulating diagnostic strategies for difficult clinical cases. However, since optimal conditions were chosen for QMR benefit in this study design, the small benefit in test scores must be weighed against the time required to teach QMR to interns.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Bacchus CM,Quinton C,O'Rourke K,Detsky ASdoi
10.1007/BF02600304subject
Has Abstractpub_date
1994-11-01 00:00:00pages
616-21issue
11eissn
0884-8734issn
1525-1497journal_volume
9pub_type
临床试验,杂志文章,随机对照试验abstract：BACKGROUND:Recurrent operational problems in teaching clinics may be caused by the different medical preferences of patients, residents, faculty, and administrators. These preference differences can be identified by cultural consensus analysis (CCA), a standard anthropologic tool. OBJECTIVE:This study tests the export...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,多中心研究
doi：10.1111/j.1525-1497.2006.00313.x
更新日期：2006-02-01 00:00:00
abstract：BACKGROUND:The three-item Brief Health Literacy Screen (BHLS) has been validated in research settings, but not in routine practice, administered by clinical personnel. OBJECTIVE:As part of the Health Literacy Screening (HEALS) study, we evaluated psychometric properties of the BHLS to validate its administration by cl...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,多中心研究
doi：10.1007/s11606-013-2568-0
更新日期：2014-01-01 00:00:00
abstract：OBJECTIVE:To describe how medical residents discuss do-not-resuscitate (DNR) orders with patients. DESIGN:Prospective observational study. SETTING:Inpatient medical wards of one university tertiary care center, one urban city public hospital, and one Veterans Affairs medical center. PARTICIPANTS:Thirty-one medical r...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02599915
更新日期：1995-08-01 00:00:00
abstract：BACKGROUND:Various stakeholders can have differing opinions regarding ethical review when introducing new procedures with patients. OBJECTIVE:This pilot study examines the way in which Research Ethics Boards (REBs; Institutional Review Boards) and clinical biochemists (CBs; laboratory medicine specialists) differ in t...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-007-0410-2
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abstract：BACKGROUND:Depression is common among older patients yet is often inadequately treated. Patient beliefs about antidepressants are known to affect treatment initiation and adherence, but are often not expressed in clinical settings. OBJECTIVE:To explore attitudes toward antidepressants in a sample of depressed, communi...
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pub_type： 杂志文章
doi：10.1111/j.1525-1497.2005.00296.x
更新日期：2006-02-01 00:00:00
abstract：BACKGROUND:Computerized physician order entry and clinical decision support systems are electronic prescribing strategies that are increasingly used to improve patient safety. Previous reviews show limited effect on patient outcomes. Our objective was to assess the impact of electronic prescribing strategies on medicat...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,meta分析
doi：10.1007/s11606-019-05236-8
更新日期：2019-10-01 00:00:00
abstract：CONTEXT:Understanding students' perceptions of and responses to lapses in professionalism is important to shaping students' professional development. OBJECTIVE:Utilize realistic, standardized professional dilemmas to obtain insight into students' reasoning and motivations in "real time." DESIGN:Qualitative study usin...
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pub_type： 杂志文章
doi：10.1111/j.1525-1497.2003.21247.x
更新日期：2003-12-01 00:00:00
abstract：:Moral distress is the experience of cognitive-emotional dissonance that arises when one feels compelled to act contrary to one's moral requirements. Moral distress is common, but under-recognized in medical education and training, and this relative inattention may undermine educators' efforts to promote empathy, ethic...
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pub_type： 杂志文章,评审
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abstract：OBJECTIVE:To define the prevalence and detection rates of mental disorders among high utilizers as compared with typical utilizers, and to examine the effect of case-mix adjustment on these parameters. DESIGN:Cross-sectional study. SETTING:General internal medicine outpatient clinic associated with an urban, academic...
journal_title：Journal of general internal medicine
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doi：10.1046/j.1525-1497.1999.07238.x
更新日期：1999-07-01 00:00:00
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journal_title：Journal of general internal medicine
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更新日期：1989-05-01 00:00:00
abstract：BACKGROUND:This study assesses the rate and predictors of treatment retention for primary care patients with opioid dependence-prescribed buprenorphine, a long-acting partial opioid agonist. METHODS:Observational cohort study of patients prescribed buprenorphine/naloxone and followed for 6 months in the period after t...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1111/j.1525-1497.2005.0228.x
更新日期：2005-11-01 00:00:00
abstract：:This study examined patient acceptance of two different advance directives. Outpatients completed the two directives and a 12-item acceptability questionnaire for each, and then stated their directive preferences. Of 128 patients enrolled, 97 (76%) responded. Overall, 47% of the respondents were satisfied with the Let...
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/BF02599143
更新日期：1994-01-01 00:00:00
abstract：OBJECTIVE:To compare the prevalence of major medical problems in homeless and nonhomeless patients. PATIENTS:All 475 persons seeking care at an ambulatory clinic serving the medically indigent for one calendar year. INTERVENTION:None. MEASUREMENTS AND MAIN RESULTS:Demographic and clinical data were collected by stru...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02598086
更新日期：1992-05-01 00:00:00
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journal_title：Journal of general internal medicine
pub_type： 杂志文章,评审
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更新日期：2007-02-01 00:00:00
abstract：BACKGROUND:In the 27 nursing homes located within the Veterans Affairs (VA) Central Region, the proportion of residents with pressure ulcers in 1986 varied from 2% to 16%. Three of these nursing homes were selected for study: nursing home A from the highest prevalence quintile, B from close to the median, and C from th...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02598281
更新日期：1993-12-01 00:00:00
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journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1111/j.1525-1497.2005.0114.x
更新日期：2005-07-01 00:00:00
abstract：OBJECTIVE:To explore colorectal cancer (CRC) screening knowledge, attitudes, barriers, and preferences among urban African Americans as a prelude to the development of culturally appropriate interventions to improve screening for this group. DESIGN:Qualitative focus group study with assessment of CRC screening prefere...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1111/j.1525-1497.2005.00165.x
更新日期：2005-11-01 00:00:00
abstract：:Over the past several decades, and particularly during the last 10 to 15 years, there has been a rapid increase in the accessibility of legalized gambling in the United States and other parts of the world. Few studies have systematically explored the relationships between patterns of gambling and health status. Existi...
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pub_type： 杂志文章,评审
doi：10.1046/j.1525-1497.2002.10812.x
更新日期：2002-09-01 00:00:00
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pub_type： 杂志文章
doi：10.1007/s11606-007-0154-z
更新日期：2007-05-01 00:00:00
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journal_title：Journal of general internal medicine
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journal_title：Journal of general internal medicine
pub_type： 临床试验,杂志文章,随机对照试验
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更新日期：1994-02-01 00:00:00
abstract：:Intravascular hemolysis is a rare but potentially life threatening cause of red urine characterized by brisk hemolysis and release of large amounts of hemoglobin into the urine. We present an unusual case of red urine in a 20-year-old male who was subsequently diagnosed with intravascular hemolysis due to an aorto-atr...
journal_title：Journal of general internal medicine
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更新日期：2010-12-01 00:00:00
abstract：BACKGROUND:For patients with peripheral arterial disease (PAD), depression is associated with worse patency and recurrent symptoms in the treated leg, but its association with death or cardiovascular events in other vascular beds is unknown. OBJECTIVE:To assess the association between depression and mortality or cardi...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
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更新日期：2008-05-01 00:00:00
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journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02602397
更新日期：1995-09-01 00:00:00
abstract：:While the association between abuse in childhood and adverse adult health outcomes is well established, this link is infrequently acknowledged in the general medical literature. This paper has 2 purposes: (1) to provide a broad overview of the research on the long-term effects of child abuse on mental and physical hea...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,评审
doi：10.1046/j.1525-1497.2003.20918.x
更新日期：2003-10-01 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：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 b...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,评审
doi：10.1007/BF02598081
更新日期：1992-05-01 00:00:00
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journal_title：Journal of general internal medicine
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更新日期：2016-09-01 00:00:00
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journal_title：Journal of general internal medicine
pub_type： 杂志文章,多中心研究
doi：10.1111/j.1525-1497.2006.00485.x
更新日期：2006-06-01 00:00:00
abstract：SPECIFIC AIM:Although the Department of Veterans Affairs (VA) has made significant organizational changes to improve diabetes care, diabetes self-management has received limited attention. The purpose of this study is to assess factors influencing diabetes self-management among veterans with poorly controlled diabetes....
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-006-0053-8
更新日期：2007-04-01 00:00:00
