Journal of General Internal Medicine

http://link.springer.com/journal/11606

List of Papers (Total 1,646)

Development of a Web-based Resident Profiling Tool to Support Training in Practice-based Learning and Improvement

Multiple factors are driving residency programs to explicitly address practice-based learning and improvement (PBLI), yet few information systems exist to facilitate such training. We developed, implemented, and evaluated a Web-based tool that provides Internal Medicine residents at the University of Virginia Health System with population-based reports about their ambulatory ...

Comparison of Electronic Physician Prompts versus Waitroom Case-Finding on Clinical Trial Enrollment

Background Recruiting patients into clinical research protocols is challenging. Electronic medical record (EMR) systems capable of prompting clinicians may facilitate enrollment. Objective To compare an EMR-based clinician prompt versus a wait-room-based case-finding strategy at enrolling patients into a clinical trial. Design Cross-sectional comparison of recruitment data from two ...

A New Age for Cancer Information Seeking: Are We Better Off Now?

Abstract A decade after the dawn of the Internet Age, are people who seek health information better off than they used to be? The current study by Arora and colleagues examines a small slice of the massive Health Information National Trends Survey dataset and attempts to understand the experiences of those US adults who have sought cancer information at any point in their lives ...

Challenging the Hidden Curriculum

The findings of Dr. Santen, Dr. Rotter, and Dr. Hemphill1 regarding physician disclosure of training level to patients may well contain few surprises for most readers. Not surprisingly, they found that such disclosure is rare and vague at best, and that patients consequently have little sense of their physician’s level of training. They also found that patients did indicate, when ...

Tips for Teachers of Evidence-Based Medicine: Understanding Odds Ratios and Their Relationship to Risk Ratios

INTRODUCTIONOdds ratios (OR) commonly appear in the medical literature summarizing the comparative effects of interventions and exposures in observational studies, randomized trials, and meta-analyses. Clinicians find it difficult to understand odds and odds ratios as measures of association, although they may be comfortable with the parallel concepts of risk and risk ratios. ...

Leveraging Primary Care in the Fight Against Lung Cancer

In recent years, the decline in youth smoking rates has stopped as the tobacco industry strives to successfully reclaim market areas where it has lost favor. The plateau in lung cancer incidence and stagnation in progress toward smoking abstinence illustrates the necessity for renewed efforts to fight tobacco use. Barriers to fighting tobacco use exist in both the clinical arena ...

Who is Responsible for Evaluating the Safety and Effectiveness of Medical Devices? The Role of Independent Technology Assessment

Introduction The global medical technology industry brings thousands of devices to market every year. However, significant gaps persist in the scientific literature, in the medical device approval process, and in the realm of postmarketing surveillance. Although thousands of drugs obtain approval only after review in randomized controlled trials, relatively few new medical devices ...

Cardiac Device Implantation in the United States from 1997 through 2004: A Population-based Analysis

OBJECTIVE Use of cardiac devices has been increasing rapidly along with concerns over their safety and effectiveness. This study used hospital administrative data to assess cardiac device implantations in the United States, selected perioperative outcomes, and associated patient and hospital characteristics. METHODS We screened hospital discharge abstracts from the 1997–2004 ...

Simulation Technology for Skills Training and Competency Assessment in Medical Education

Medical education during the past decade has witnessed a significant increase in the use of simulation technology for teaching and assessment. Contributing factors include: changes in health care delivery and academic environments that limit patient availability as educational opportunities; worldwide attention focused on the problem of medical errors and the need to improve ...

Improving Sedative-Hypnotic Prescribing in Older Hospitalized Patients: Provider-Perceived Benefits and Barriers of a Computer-Based Reminder

Background Older adults are commonly prescribed sedative-hypnotic (SH) medications when hospitalized, yet these drugs are associated with important adverse effects such as falls and delirium. Objective To identify provider-perceived benefits or barriers of a computer-based reminder regarding appropriate use of SH medications. Design Qualitative study using semi-structured ...

Proteomics as a Method for Early Detection of Cancer: A Review of Proteomics, Exhaled Breath Condensate, and Lung Cancer Screening

The study of expressed proteins in neoplasia is undergoing a revolution with the advent of proteomic analysis. Unlike genomic studies where individual changes may have no functional significance, protein expression is closely aligned with cellular activity. This perspective will review proteomics as a method of detecting markers of neoplasia with a particular emphasis on lung ...

Within You / Without You: Biotechnology, Ontology, and Ethics

As Implantable Cardioverter Defibrillators (ICDs) have become more common, ethical issues have arisen regarding the deactivation of these devices. Goldstein et al., have shown that both patients and cardiologists consider ICD deactivation to be different from the discontinuation of other life-sustaining treatments. It cannot be argued ethically that ICDs raise new questions about ...

Telecardiology and Remote Monitoring of Implanted Electrical Devices: The Potential for Fresh Clinical Care Perspectives

Telecardiology may help confront the growing burden of monitoring the reliability of implantable defibrillators/pacemakers. Herein, we suggest that the evolving capabilities of implanted devices to monitor patients’ status (heart rhythm, fluid overload, right ventricular pressure, oximetry, etc.) may imply a shift from strictly device-centered follow-up to perspectives centered on ...

Evaluation of Clinical Innovation: A Gray Zone in the Ethics of Modern Clinical Practice?

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 their interpretation of what is research and what should be ...

Economic Implications of Potential Changes to Regulatory and Reimbursement Policies for Medical Devices

Objective To evaluate the impact of regulatory scenarios on the financial viability of medical device companies. Design We developed a model to calculate the expected net present value of a hypothetical product throughout preclinical development, clinical testing, regulatory approval, and postmarketing. We tested 3 scenarios: (1) the current regulatory environment; (2) a scenario ...

“That’s Like an Act of Suicide” Patients’ Attitudes Toward Deactivation of Implantable Defibrillators

Objective To understand potential patient barriers to discussions about implantable cardioverter defibrillator (ICD) deactivation in patients with advanced illness. Design Qualitative focus groups. Participants Fifteen community-dwelling, ambulatory patients with ICDs assigned to focus groups based on duration of time since implantation and whether they had ever received a shock ...