4523. Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians.
作者: Amir Qaseem.;Vincenza Snow.;Patricia Barry.;E Rodney Hornbake.;Jonathan E Rodnick.;Timothy Tobolic.;Belinda Ireland.;Jodi B Segal.;Eric B Bass.;Kevin B Weiss.;Lee Green.;Douglas K Owens.; .
来源: Ann Intern Med. 2007年146卷6期454-8页
This guideline summarizes the current approaches for the diagnosis of venous thromboembolism. The importance of early diagnosis to prevent mortality and morbidity associated with venous thromboembolism cannot be overstressed. This field is highly dynamic, however, and new evidence is emerging periodically that may change the recommendations. The purpose of this guideline is to present recommendations based on current evidence to clinicians to aid in the diagnosis of lower extremity deep venous thrombosis and pulmonary embolism.
4524. "I'm not ready for hospice": strategies for timely and effective hospice discussions.
Hospice programs offer unique benefits for patients who are near the end of life and their families, and growing evidence indicates that hospice can provide high-quality care. Despite these benefits, many patients do not enroll in hospice, and those who enroll generally do so very late in the course of their illness. Some barriers to hospice referral arise from the requirements of hospice eligibility, which will be difficult to eliminate without major changes to hospice organization and financing. However, the challenges of discussing hospice create other barriers that are more easily remedied. The biggest communication barrier is that physicians are often unsure of how to talk with patients clearly and directly about their poor prognosis and limited treatment options (both requirements of hospice referral) without depriving them of hope. This article describes a structured strategy for discussing hospice, based on techniques of effective communication that physicians use in other "bad news" situations. This strategy can make hospice discussions both more compassionate and more effective.
4529. Nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors for primary prevention of colorectal cancer: a systematic review prepared for the U.S. Preventive Services Task Force.
作者: Alaa Rostom.;Catherine Dubé.;Gabriela Lewin.;Alexander Tsertsvadze.;Nicholas Barrowman.;Catherine Code.;Margaret Sampson.;David Moher.; .
来源: Ann Intern Med. 2007年146卷5期376-89页
To examine the benefits and harms of nonaspirin (non-ASA) nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase (COX-2) inhibitors for the prevention of colorectal cancer (CRC) and adenoma.
4530. The use of aspirin for primary prevention of colorectal cancer: a systematic review prepared for the U.S. Preventive Services Task Force.
作者: Catherine Dubé.;Alaa Rostom.;Gabriela Lewin.;Alexander Tsertsvadze.;Nicholas Barrowman.;Catherine Code.;Margaret Sampson.;David Moher.; .
来源: Ann Intern Med. 2007年146卷5期365-75页
Aspirin for prevention of colorectal cancer is controversial.
4533. Systematic review: the value of the periodic health evaluation.
作者: L Ebony Boulware.;Spyridon Marinopoulos.;Karran A Phillips.;Constance W Hwang.;Kenric Maynor.;Dan Merenstein.;Renee F Wilson.;George J Barnes.;Eric B Bass.;Neil R Powe.;Gail L Daumit.
来源: Ann Intern Med. 2007年146卷4期289-300页
The periodic health evaluation (PHE) has been a fundamental part of medical practice for decades despite a lack of consensus on its value.
4534. The effectiveness of a primer to help people understand risk: two randomized trials in distinct populations.
People need basic data interpretation skills to understand health risks and to weigh the harms and benefits of actions meant to reduce those risks. Although many studies document problems with understanding risk information, few assess ways to teach interpretation skills.
4536. Tiotropium in combination with placebo, salmeterol, or fluticasone-salmeterol for treatment of chronic obstructive pulmonary disease: a randomized trial.
作者: Shawn D Aaron.;Katherine L Vandemheen.;Dean Fergusson.;François Maltais.;Jean Bourbeau.;Roger Goldstein.;Meyer Balter.;Denis O'Donnell.;Andrew McIvor.;Sat Sharma.;Graham Bishop.;John Anthony.;Robert Cowie.;Stephen Field.;Andrew Hirsch.;Paul Hernandez.;Robert Rivington.;Jeremy Road.;Victor Hoffstein.;Richard Hodder.;Darcy Marciniuk.;David McCormack.;George Fox.;Gerard Cox.;Henry B Prins.;Gordon Ford.;Dominique Bleskie.;Steve Doucette.;Irvin Mayers.;Kenneth Chapman.;Noe Zamel.;Mark FitzGerald.; .
来源: Ann Intern Med. 2007年146卷8期545-55页
Treatment of moderate or severe chronic obstructive pulmonary disease (COPD) with combinations of inhaled corticosteroids, long-acting beta-agonists, and long-acting anticholinergic bronchodilators is common but unstudied.
4538. Brief communication: National quality-of-care standards in home-based primary care.
Home-based primary care for homebound seniors is complex, and practice constraints are unique. No quality-of-care standards exist.
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