Abstract：
OBJECTIVE:To assess the risks and benefits of surgery for herniated lumbar discs (discectomy) and to evaluate the methodologic quality of the literature. DESIGN:Literature synthesis. STUDY SELECTION AND DATA ANALYSIS: A structured MEDLINE search identified studies of standard, microsurgical, or percutaneous discectomy. Eligible studies had adult subjects, sample sizes of > or = 30, clinical outcome data for > or = 75% of patients, and follow-up of > or = 1 year. Summary rates of successful outcomes, reoperations, and complications were obtained by a random-effects logistic regression model. Methodologic quality was assessed using established study design criteria. RESULTS:Eighty-one studies met inclusion criteria. Most had substantial design flaws and/or omitted important clinical data. Randomized trials of standard discectomy showed better short-term sciatica relief following surgery; 65% to 85% of patients reported no sciatica one year after surgery, compared with only 36% of conservatively treated patients. No data from randomized trials were available for microdiscectomy or percutaneous discectomy, although most outcomes appeared comparable to those of standard discectomy. Approximately 10% of discectomy patients underwent further back surgery, and rates increased over time. The rate of serious complications, including death and permanent neurologic damage, was less than 1%. CONCLUSIONS:Most studies were poorly designed and reported. Standard discectomy appears to offer better short-term outcomes than does conservative treatment, but long-term outcomes are similar. Discectomies are relatively safe procedures, though reoperations are common and increase over time. Decisions for elective surgery must balance faster pain relief against the risks and costs of surgery.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Hoffman RM,Wheeler KJ,Deyo RAdoi
10.1007/BF02600110subject
Has Abstractpub_date
1993-09-01 00:00:00pages
487-96issue
9eissn
0884-8734issn
1525-1497journal_volume
8pub_type
杂志文章,meta分析abstract：OBJECTIVES:To assess the prevalence and persistence of depression in patients with acute myocardial infarction (AMI) and the relationship between assessment modality and prevalence. DATA SOURCES:MEDLINE, Cochrane, CINAHL, PsycINFO, and EMBASE. REVIEW METHODS:A comprehensive search was conducted in March 2004 to ident...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,评审
doi：10.1111/j.1525-1497.2005.00269.x
更新日期：2006-01-01 00:00:00
abstract：BACKGROUND:Several policymakers have suggested that the Affordable Care Act (ACA) has fueled the opioid epidemic by subsidizing opioid pain medications. These claims have supported numerous efforts to repeal the ACA. OBJECTIVE:To determine the effect of the ACA's young adult dependent coverage insurance expansion on e...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-019-05605-3
更新日期：2020-06-01 00:00:00
abstract：BACKGROUND:Many patient education materials (PEMs) available on the internet are written at high school or college reading levels, rendering them inaccessible to the average US resident, who reads at or below an 8(th) grade level. Currently, electronic health record (EHR) providers partner with companies that produce P...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,随机对照试验
doi：10.1007/s11606-012-2046-0
更新日期：2012-09-01 00:00:00
abstract：BACKGROUND:Despite the importance of professionalism, little is known about how burnout relates to professionalism among practicing physicians. OBJECTIVE:To evaluate the relationship between burnout and professional behaviors and cost-conscious attitudes. DESIGN AND PARTICIPANTS:Cross-sectional study in a national sa...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-019-05376-x
更新日期：2020-05-01 00:00:00
abstract：BACKGROUND:Little is known about whether more experience with an electronic health record (EHR) makes it easier for providers to meaningfully use EHRs. OBJECTIVE:To assess whether the length of time that small practice providers have been using the EHR is associated with greater ease in performing meaningful use-relat...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-014-2891-0
更新日期：2014-10-01 00:00:00
abstract：BACKGROUND:A significant barrier to communication among patient care providers in hospitals is the geographic dispersion of team members. OBJECTIVE:To determine whether localizing physicians to specific patient care units improves nurse-physician communication and agreement on patients' plans of care. METHODS:We cond...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-009-1113-7
更新日期：2009-11-01 00:00:00
abstract：BACKGROUND:Patient-provider sexual risk behavior discussions occur infrequently but may be facilitated by high-quality sexual risk screening tools. OBJECTIVE:To develop the Sexual Risk Behavior Inventory (SRBI), a brief computer-administered patient-reported measure. DESIGN:Qualitative item development/quantitative i...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,多中心研究
doi：10.1007/s11606-018-4496-5
更新日期：2018-10-01 00:00:00
abstract：BACKGROUND:The placebo and the placebo effect are often investigated in the context of clinical trials. Little data exist on the use of placebos in the course of routine health care. OBJECTIVE:The aim of this study is to describe a group of academic physicians' use of placebos and their knowledge, attitudes, and belie...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-007-0332-z
更新日期：2008-01-01 00:00:00
abstract：BACKGROUND:The Medicare Accountable Care Organization (ACO) programs encourage integration of providers into large groups and reward provider groups for improving quality, but not explicitly for reducing health care disparities. Larger group size and better overall quality may or may not be associated with smaller disp...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,随机对照试验
doi：10.1007/s11606-014-2900-3
更新日期：2014-09-01 00:00:00
abstract：:To investigate the frequency of physician delivery of advice to stop smoking and patient characteristics affecting whether physicians deliver such advice, the authors surveyed 97 current cigarette smokers seen in two specialty and one general medicine clinic at a university medical center. Approximately two thirds of ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02596170
更新日期：1987-09-01 00:00:00
abstract：BACKGROUND:Despite recent reductions in national unplanned readmission rates, we have relatively little understanding of which hospital strategies are most associated with changes in risk-standardized readmission rates (RSRR). OBJECTIVE:We examined associations between the change in hospital 30-day RSRR for patients w...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,多中心研究
doi：10.1007/s11606-014-3105-5
更新日期：2015-05-01 00:00:00
abstract：:The American Board of Internal Medicine suggests use of a standard form to rate residents on nine dimensions (such as clinical judgment and overall clinical competence) on a scale of 1 to 9. The authors examined the psychometric evidence for reliability and validity of 1,039 ratings of 85 residents by 135 attendings i...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02600537
更新日期：1990-05-01 00:00:00
abstract：BACKGROUND:While victims of intimate partner violence (IPV) present to health care settings for a variety of complaints; rates and predictors of case identification and intervention are unknown. OBJECTIVE:Examine emergency department (ED) case finding and response within a known population of abused women. DESIGN:Ret...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-011-1662-4
更新日期：2011-08-01 00:00:00
abstract：BACKGROUND:Post-hospital discharge follow-up appointments are intended to evaluate patients' recovery following a hospitalization, but it is unclear how appointment statuses are associated with readmissions. OBJECTIVE:To examine the association between post-discharge ambulatory follow-up status, (1) having a scheduled...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-020-06569-5
更新日期：2021-01-19 00:00:00
abstract：OBJECTIVE:To determine patient characteristics associated with patient and proxy perceptions of physicians' recommendations for life-prolonging care versus comfort care, and with acceptance of such recommendations. DESIGN:Cross-sectional. SETTING:Five teaching hospitals in Denver, Colo. PATIENTS:We studied 239 hospi...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,多中心研究
doi：10.1111/j.1525-1497.2000.07004.x
更新日期：2000-04-01 00:00:00
abstract：:Our institution has instituted "short-call" and "nightfloat" systems to reduce the number of admissions to the traditional "long-call" housestaff. However, the nightfloat system introduces increased discontinuity to patient care, and interns may spend less time with short-call patients because they are nor required to...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1046/j.1525-1497.1997.012005308.x
更新日期：1997-05-01 00:00:00
abstract：BACKGROUND:Racial and ethnic minority groups have lower levels of leisure-time physical activity (LTPA) than whites, but it is unclear how much of this is explained by differences in socioeconomic status and health. OBJECTIVE:To examine differences in LTPA, work-related physical activity (WRPA; heavy household chores ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1111/j.1525-1497.2005.40198.x
更新日期：2005-03-01 00:00:00
abstract：:We describe a half-day workshop to teach third-year medical students three focused end-of-life care skills: breaking bad news, discussing advance directives, and assessing and managing pain. Our workshop included a readers' theater exercise and three role-play exercises. In two of the workshops, faculty members played...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1111/j.1525-1497.2004.30115.x
更新日期：2004-05-01 00:00:00
abstract：BACKGROUND:Mind-body practices such as yoga are widely popular, but little is known about how such exercises impact health-related quality of life. OBJECTIVE:To measure changes in health-related quality of life associated with 3 months of mind-body training as practiced in community-based settings. DESIGN:Prospective...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1111/j.1525-1497.2004.30011.x
更新日期：2004-07-01 00:00:00
abstract：BACKGROUND:Consumer-directed health plans are increasingly common, yet little is known about their impact on physician decision-making and preventive service use. OBJECTIVE:To determine how patients' deductible levels and socioeconomic status may affect primary care physicians' recommendations for colorectal cancer sc...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,随机对照试验
doi：10.1007/s11606-008-0714-x
更新日期：2008-10-01 00:00:00
abstract：OBJECTIVE:To compare the abilities of two methods for rapid detection of pyuria and three methods of urinalysis to predict significant bacteriuria in symptomatic ambulatory women. DESIGN:Prospective simultaneous comparison of the results of dipstick urinalysis, standard microscopic urinalysis, and hemocytometric cell ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02598002
更新日期：1992-03-01 00:00:00
abstract：OBJECTIVE:To examine the relationship between resident physicians' perceptions of their preventive cardiology practices and a chart audit assessment of their documented services. DESIGN:A criterion standard comparison of two methods used to assess resident physicians' practices: self-report and chart audit. SETTING:P...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02600254
更新日期：1995-04-01 00:00:00
abstract：BACKGROUND:Many American Indian and Alaska Native veterans are eligible for healthcare from Veterans Health Administration (VHA) and from Indian Health Service (IHS). These organizations executed a Memorandum of Understanding in 2003 to share resources, but little was known about how they collaborated to deliver health...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-009-0962-4
更新日期：2009-06-01 00:00:00
abstract：BACKGROUND:Despite evidence of inadequate physical examination skills among medical students, teaching these skills has declined. One method of enhancing inspection skills is teaching "visual literacy," the ability to reason physiology and pathophysiology from careful and unbiased observation. OBJECTIVE:To improve stu...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,随机对照试验
doi：10.1007/s11606-008-0667-0
更新日期：2008-07-01 00:00:00
abstract：BACKGROUND:Although experts recommend that healthcare organizations create forums for honest dialogue about race, there is little insight into the physician perspectives that may influence these conversations across the healthcare workforce. OBJECTIVE:To identify the range of perspectives that might contribute to work...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-008-0709-7
更新日期：2008-09-01 00:00:00
abstract：BACKGROUND:Obesity and its related co-morbidities place a huge burden on the health care system. Patients who know they are obese may better control their weight or seek medical attention. Self-recognition may be affected by race/ethnicity, but little is known about racial/ethnic differences in knowledge of obesity's h...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,多中心研究
doi：10.1007/s11606-010-1623-3
更新日期：2011-06-01 00:00:00
abstract：OBJECTIVE:Internet and other interactive technology-based programs offer great potential for practical, effective, and cost-efficient diabetes self-management (DSM) programs capable of reaching large numbers of patients. This study evaluated minimal and moderate support versions of an Internet-based diabetes self-manag...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,随机对照试验
doi：10.1007/s11606-010-1480-0
更新日期：2010-12-01 00:00:00
abstract：:Attempts to explain the high cost of care in teaching hospitals have yielded conflicting results. This study was conducted to compare hospital charges and lengths of stay for two groups of patients: one cared for by a resident team and the other cared for by attending physicians. The study was conducted at a universit...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02602350
更新日期：1989-03-01 00:00:00
abstract：OBJECTIVE:To determine whether depressive symptoms measured at baseline are associated with mortality and to describe the course of depressive symptoms and their relation to physical decline in patients over a 6-year period. DESIGN:Prospective cohort study conducted from 1990 through 1996. SETTING:Urban academic prim...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1046/j.1525-1497.1998.00226.x
更新日期：1998-11-01 00:00:00
abstract：OBJECTIVE:Methods of assessing humanism in internal medicine residents have not been completely designed or evaluated. This study used patient satisfaction as a measure of humanism, and assessed the validity of using faculty physicians to evaluate residents' humanistic behavior. Residents' ability to assess themselves ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02599551
更新日期：1989-11-01 00:00:00
