The patient
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: Prostate-specific antigen (PSA) screening is controversial because of uncertainty about whether it reduces mortality and whether the potential benefits outweigh the harms. Given these uncertainties, many medical associations recommend using an informed decision-making (IDM) process for making decisions about PSA screening, so that men can make well informed decisions that reflect their values and preferences. ⋯ : Ongoing education about the US Preventive Services Task Force (USPSTF) recommendation with respect to PSA screening should occur not only at the patient level but also at the provider level. More widespread adoption of the IDM process, which inherently involves building a patient's self-efficacy and skills needed to engage in it, is likely to take time.
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In Crossing the Quality Chasm, the Institute of Medicine recommended that patient-centered care should not waste patients' time and should recognize the involvement of family and friends. Studies have documented the time spent by physicians on outpatient visits, but not that spent by patients and their companions. The patient's perspective provides an important yet overlooked indicator of healthcare effectiveness. ⋯ Outpatient visits are time intensive for American patients and their families: the equivalent of 207 million 40-hour work-weeks each year. Patients and their families spend substantially more time on outpatient visits than the time with the physician reported by the annual National Ambulatory Medical Care Survey. Further research is needed on the components of outpatient visits that do not directly involve physicians. Efforts to improve care should address waiting times and recognize the involvement of family members. The ATUS could provide periodic benchmarks of patient time use as a supplement to other indicators of patient-centered care in the annual National Healthcare Quality Report.
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Chronic osteoarthritis (OA) pain impacts health-related quality of life (HR-QOL). ⋯ Both OROS hydromorphone and ER oxycodone improved sleep and function, with greater sleep benefits being observed in patients treated with OROS hydromorphone.