Journal of general internal medicine
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To determine changes in the use of do-not-resuscitate (DNR) orders and mortality rates following a DNR order after the Patient Self-determination Act (PSDA) was implemented in December 1991. ⋯ Overall use of DNR orders changed relatively little after passage of the PSDA, because the increase in the use of early DNR orders between 1991 and 1992 was counteracted by decreasing use of late DNR orders. Risk-adjusted mortality rates after a DNR order generally remained stable, suggesting that there were no dramatic changes in quality of care or aggressiveness of care for patients with DNR orders. However, the increasing mortality for stroke patients warrants further examination.
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To determine physicians' rating of the importance of key facts men ought to know about prostate-specific antigen (PSA) screening and whether there are differences by specialty. ⋯ Despite professional guidelines supporting informed decision making, the importance of facts men ought to know about PSA testing differ by physician specialty. Systematic differences may reflect differences in professional guidelines about PSA testing.
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To describe medical students' mentoring relationships and determine characteristics associated with having mentors, 232/302 (77%) of third- and fourth-year medical students at the University of California at San Francisco (UCSF) were surveyed. Twenty-six percent of third-year and 45% of fourth-year students had mentors. Most met their mentors during inpatient clerkships (28%), research (19%), or sought them on the basis of similar interests (23%). On multivariate analysis, students who performed research prior to (odds ratio [OR], 4.8; 95% confidence interval [95% CI], 1.4 to 16.7; P =.01) or during medical school (OR, 2.4; 95% CI, 1.1 to 5.6; P =.03) and students satisfied with advising from all sources at UCSF (OR, 1.8; 95% CI, 1.4 to 2.4; P <.001) were more likely to have mentors.
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This study compared the relative efficiency of lumbar x-ray and rapid magnetic resonance (MR) imaging for diagnosing cancer-related low back pain (LBP) in primary care patients. ⋯ There is currently not enough evidence to support the routine use of rapid MR to detect cancer as a cause of LBP in primary care patients.