Journal of general internal medicine
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Randomized Controlled Trial Multicenter Study
Incorporating PROMIS Symptom Measures into Primary Care Practice-a Randomized Clinical Trial.
Symptoms account for more than 400 million clinic visits annually in the USA. The SPADE symptoms (sleep, pain, anxiety, depression, and low energy/fatigue) are particularly prevalent and undertreated. ⋯ Simple feedback of symptom scores to primary care clinicians in the absence of additional systems support or incentives is not superior to usual care in improving symptom outcomes.
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Review
Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral Nor Appropriate.
It has been proposed that medical organizations adopt neutrality with respect to physician-assisted suicide (PAS), given that the practice is legal in some jurisdictions and that membership is divided. We review developments in end-of-life care and the role of medical organizations with respect to the legalization of PAS since the 1990s. We argue that moving from opposition to neutrality is not ethically neutral, but a substantive shift from prohibited to optional. ⋯ Moreover, on an issue so central to the meaning of medical professionalism, it seems important for organized medicine to take a stand. We subsequently review the arguments in favor of PAS (arguments from autonomy and mercy, and against the distinction between killing and allowing to die (K/ATD)) and the arguments against legalization (the limits of autonomy, effects on the patient-physician relationship, the meaning of healing, the validity of the K/ATD distinction, the social nature of suicide, the availability of alternatives, the propensity for incremental extension, and the meaning of control). We conclude that organized medicine should continue its opposition to PAS.
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Decision makers rely on meta-analytic estimates to trade off benefits and harms. Publication bias impairs the validity and generalizability of such estimates. The performance of various statistical tests for publication bias has been largely compared using simulation studies and has not been systematically evaluated in empirical data. ⋯ Given the relatively low agreement between many publication bias tests, meta-analysts should not rely on a single test and may apply multiple tests with various assumptions. Non-statistical approaches to evaluating publication bias (e.g., searching clinical trials registries, records of drug approving agencies, and scientific conference proceedings) remain essential.
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Some have questioned whether successful performance in the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program is meaningful. The association of the ABIM Internal Medicine (IM) MOC examination with state medical board disciplinary actions is unknown. ⋯ Passing a periodic assessment of medical knowledge is associated with decreased state medical board disciplinary actions, an important quality outcome of relevance to patients and the profession.
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Randomized Controlled Trial Multicenter Study Pragmatic Clinical Trial
Effect of Low Back Pain Risk-Stratification Strategy on Patient Outcomes and Care Processes: the MATCH Randomized Trial in Primary Care.
The STarT Back strategy for categorizing and treating patients with low back pain (LBP) improved patients' function while reducing costs in England. ⋯ A resource-intensive intervention to support stratified care for LBP in a US healthcare setting had no effect on patient outcomes or healthcare use.