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 information about prostate-specific antigen (PSA) testing and the uncertain benefits of treating prostate cancer affects patients' desire for PSA testing. DESIGN:An educational videotape designed to inform men about the uncertainty surrounding PSA screening and the treatment of early-stage prostate cancer was presented to two groups of male patients 50 years of age or older. SETTING:Dartmouth-Hitchcock Medical Center. PATIENTS/PARTICIPANTS:For study 1, men seeking a free prostate cancer screening were preassigned to view the educational videotape (N = 184) or another videotape (N = 185). For study 2, men scheduled to visit a general internal medicine clinic viewed either the educational videotape (N = 103) or no videotape (N = 93). MEASUREMENTS AND MAIN RESULTS:The men's information and preferences about prostate cancer screening and treatment and actual choice of PSA test at the next test opportunity were measured. Men who viewed the educational videotape were: better informed about PSA tests, prostate cancer, and its treatment; preferred no active treatment if cancer were found; and preferred not to be screened (all significant at p < or = .002 in both studies). Men viewing the educational video were less likely to have a PSA test (p = .041, study 2). This tendency was not significant at the free-PSA clinic (p = .079). CONCLUSIONS:Preference regarding cancer screening and treatment is greatly affected by information about medical uncertainties. Because informed patient choices vary. PSA screening decisions should incorporate individual preferences.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Flood AB,Wennberg JE,Nease RF Jr,Fowler FJ Jr,Ding J,Hynes LMdoi
10.1007/BF02600045subject
Has Abstractpub_date
1996-06-01 00:00:00pages
342-9issue
6eissn
0884-8734issn
1525-1497journal_volume
11pub_type
临床试验,杂志文章abstract:BACKGROUND:Hemophilia A is a rare, sex-linked genetic disorder treated with intravenous administration of factor VIII (FVIII) to prevent bleeding; however, approaches vary across and within countries. Value-of-information (VOI) methods identify situations in which the cost-benefit evidence is sufficient to adopt one tr...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-2880-3
更新日期:2014-08-01 00:00:00
abstract:OBJECTIVE:To evaluate patient-provider agreement on whether weight and related behaviors were discussed during routine visits. DESIGN:Post-visit survey assessments of patients and providers. PARTICIPANTS:Obese patients make up the majority of all patients seen in primary care (PC). The patients and physicians were re...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0553-9
更新日期:2008-05-01 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
abstract::Much of medical practice involves the exercise of such basic cognitive tasks as estimating probabilities and synthesizing information. Scientists studying cognitive processes have identified impediments to accurate performance on these tasks. Together the impediments foster "cognitive bias." Five factors that can detr...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/BF02596149
更新日期:1987-05-01 00:00:00
abstract:BACKGROUND:Resident duty hour restrictions have resulted in more frequent patient care handoffs, increasing the need for improved quality of residents' sign-out process. OBJECTIVE:To characterize resident sign-out process and identify effective strategies for quality improvement. DESIGN:Mixed methods analysis of resi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-011-1885-4
更新日期:2012-03-01 00:00:00
abstract::Twenty-five to sixty percent of physicians report burnout across all specialties. Changes in the healthcare environment have created marked and growing external pressures. In addition, physicians are predisposed to burnout due to internal traits such as compulsiveness, guilt, and self-denial, and a medical culture tha...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-014-3144-y
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Discharge planning is an important component of hospital care. The Blaylock Risk Assessment Screening Score (BRASS) index is an instrument used to identify patients requiring complex discharge planning. OBJECTIVES:(1) Evaluate the ability of the original BRASS index to predict the risk of complex discharge ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4405-y
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:In 2005 the Spoken Knowledge in Low Literacy in Diabetes scale (SKILLD) was introduced as a diabetes knowledge test. The SKILLD has not been validated since its introduction. OBJECTIVE:To perform a validation analysis on the SKILLD. DESIGN AND PARTICIPANTS:Cross-sectional observational study of 240 patient...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-011-1900-9
更新日期:2012-02-01 00:00:00
abstract:OBJECTIVE:To determine whether a Bayesian method of lung scan (LS) reporting could influence the management of patients with suspected pulmonary embolism (PE). DESIGN:1) A descriptive study of the diagnostic process for suspected PE using the new reporting method; 2) a non-experimental evaluation of the reporting meth...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600392
更新日期:1990-07-01 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
doi:10.1007/s11606-008-0560-x
更新日期:2008-05-01 00:00:00
abstract::This paper deals with the varied sites and teachers that can and should be used in educating residents and medical students in ambulatory care. A basic premise is that sites other than academic medical centers and teachers other than physician faculty members should be among those used. The paper describes how institu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600436
更新日期:1990-01-01 00:00:00
abstract:BACKGROUND:With the reorganization of primary care into Patient Aligned Care Teams (PACT) teams, the Veteran Affairs Health System (VA) aims to ensure all patients receive care based on patient-centered medical home (PCMH) principles. However, some patients receive the preponderance of care from specialty rather than p...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-013-2677-9
更新日期:2014-07-01 00:00:00
abstract:OBJECTIVE:Determine patient and hospital-level variation in proportions of low-severity admissions. DESIGN:Retrospective cohort study. SETTING:Thirty hospitals in a large metropolitan region. PATIENTS:A total of 43,209 consecutive eligible patients discharged in 1991 through 1993 with congestive heart failure (n = 2...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1046/j.1525-1497.1997.00073.x
更新日期:1997-07-01 00:00:00
abstract:BACKGROUND:Due to a shortage of studies focusing on older adults, clinicians and policy makers frequently rely on clinical trials of the general population to provide supportive evidence for treating complex, older patients. OBJECTIVES:To examine the inclusion and analysis of complex, older adults in randomized contro...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-010-1629-x
更新日期:2011-07-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to identify potential explanatory factors for racial differences in blood pressure (BP) control. DESIGN:The design of the study was a cross-sectional study PATIENTS/PARTICIPANTS:The study included 608 patients with hypertension who were either African American (50%) or white (...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-008-0547-7
更新日期:2008-05-01 00:00:00
abstract:BACKGROUND:Many scholars have written about the historical underpinnings and likely consequences of African Americans distrust in health care, yet little research has been done to understand if and how this distrust affects African Americans' current views of the trustworthiness of physicians. OBJECTIVE:To better unde...
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::Physicians and patients increasingly use social media technologies, such as Facebook, Twitter, and weblogs (blogs), both professionally and personally. Amidst recent reports of physician misbehavior online, as well as concerns about social media's potential negative effect on trust in the medical profession, several n...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-012-2251-x
更新日期:2013-02-01 00:00:00
abstract:BACKGROUND:Genomics will play an increasingly prominent role in clinical medicine. OBJECTIVE:To describe how primary care physicians (PCPs) discuss and make clinical recommendations about genome sequencing results. DESIGN:Qualitative analysis. PARTICIPANTS:PCPs and their generally healthy patients undergoing genome ...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s11606-017-4295-4
更新日期:2018-06-01 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...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-013-2665-0
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:Since the 2011 Accreditation Council of Graduate Medical Education (ACGME) work hour rules for residents were implemented, 24-30 h call for interns has been replaced by shift work, including night-float. The impact of these changes on undergraduate medical education experiences in internal medicine has not b...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-015-3405-4
更新日期:2015-09-01 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
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doi:10.1007/s11606-011-1662-4
更新日期:2011-08-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-015-3295-5
更新日期:2015-09-01 00:00:00
abstract:OBJECTIVE:To examine the characteristics and outcomes of physician-referred weight management patients relative to self-referred patients. DESIGN:Review of clinic records of all individuals contacting a weight control program during a 2-year period with follow-up throughout consecutive levels of treatment (i.e., enrol...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2002.11028.x
更新日期:2002-08-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Thyroid ultrasound (TUS) plays an important but limited role in the evaluation of some complaints related to the thyroid gland. This study was designed to examine how primary care physicians use TUS before referring patients to an endocrine clinic. DESIGN:We audited all charts of first-time r...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2005.0124.x
更新日期:2005-08-01 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
abstract:OBJECTIVES:The telephone can facilitate medical care but also result in adverse outcomes leading to telephone-related malpractice suits. Analyzing claims might identify errors amenable to prevention. The objective of the study was to describe medical errors involving the telephone in patient-clinician encounters that s...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0491-y
更新日期:2008-05-01 00:00:00
abstract:BACKGROUND:Whether patients' reports of gaps in care coordination reflect clinically significant problems is unclear. OBJECTIVE:To determine any association between patient-reported gaps in care coordination and patient-reported preventable adverse outcomes. DESIGN AND PARTICIPANTS:We administered a cross-sectional s...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06047-y
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Urine drug testing (UDT) is an essential tool to monitor opioid misuse among patients on chronic opioid therapy. Inaccurate interpretation of UDT can have deleterious consequences. Providers' ability to accurately interpret and document UDT, particularly definitive liquid chromatography-tandem mass spectrome...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05514-5
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:In a study conducted over 3 large symposia on intensive review of internal medicine, we previously assessed the features that were most important to course participants in evaluating the quality of a lecture. In this study, we attempt to validate these observations by assessing prospectively the extent to whi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2000.06439.x
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVE:To evaluate the accuracy of a preliminary diagnosis based solely on patient history and physical examination in medical outpatients with abdominal or chest pain. DESIGN:Prospective observational study. SETTING:General medical outpatient clinic in a university teaching hospital. PARTICIPANTS:One hundred nin...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1997.00083.x
更新日期:1997-08-01 00:00:00