***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Very little effort has been directed to enable GPs to better informed decisions about PSA screening among their male patients . OBJECTIVES To evaluate an innovative programme design ed to enhance GPs ' capacity to promote informed decision making by male patients about PSA screening . METHODS The study design was a cluster r and omised controlled trial set in New South Wales , Australia 's most populous state . 277 GPs were recruited through a major pathology laboratory . The interventions were three telephone-administered ' peer coaching ' sessions integrated with educational re sources for GPs and patients and the main outcome measures were : GP knowledge ; perceptions of patient involvement in informed decision making ; GPs ' own decisional conflict ; and perceptions of medicolegal risk . RESULTS Compared with GPs allocated to the control group , GPs allocated to our intervention gained significantly greater knowledge about PSA screening and related information [ Mean 6.1 out of 7 ; 95 % confidence interval ( CI ) = 5.9 - 6.3 versus 4.8 ; 95 % CI = 4.6 - 5.0 ; P < 0.001 ] . They were less likely to agree that patients should remain passive when making decisions about PSA screening [ Odds ratio ( OR ) = 0.11 ; 95 % CI = 0.04 - 0.31 ; P < 0.001 ] . They perceived less medicolegal risk when not acceding to an ' uninformed ' patient request for a PSA test ( OR = 0.31 ; 95 % CI 0.19 - 0.51 ) . They also demonstrated lower levels of personal decisional conflict about the PSA screening ( Mean 25.4 ; 95 % CI 24.5 - 26.3 versus 27.8 ; 95 % CI 26.6 - 29.0 ; P = 0.0002 ) . CONCLUSION A ' peer coaching ' programme , supplemented by education material s , holds promise as a strategy to equip GPs to facilitate informed decision making amongst their patients The aim of this secondary analysis was to compare the effects of a tailored decision aid ( DA ) with those of a pamphlet on the agreement between women 's and physicians ' decisional conflict about hormone replacement therapy ( HRT ) . A total of 40 physicians and 184 women provided data . The agreement between women 's and physicians ' decisional conflict scores was measured using the intraclass correlation coefficient ( ICC ) . The ICC was higher for dyads in the DA group ( ICC=0.44 ; 95 % confidence interval (CI)=0.25 - 0.59 ) compared to the pamphlet group ( ICC=0.28 ; 95 % CI=0.06 - 0.47 ) . When the average score of decisional conflict of women nested within a physician and of each physician were used , the ICC for the DA group and the pamphlet group was 0.41 ( 95 % CI=-0.04 to 0.72 ) and 0.06 ( 95 % CI=-0.41 to 0.49 ) , respectively . Compared to pamphlets , DAs appear to improve the agreement between women 's and physicians ' decisional conflict about HRT Objective : To explore factors associated with the difference in score between women 's and doctors ’ decisional conflict about hormone therapy ( HT ) Background There are increasing numbers of r and omised trials and systematic review s examining the efficacy of interventions design ed to bring about a change in clinical practice . The findings of this research are being used to guide strategies to increase the uptake of evidence into clinical practice . Knowledge of the outcomes measured by these trials is vital not only for the interpretation and application of the work done to date , but also to inform future research in this exp and ing area of endeavour and to assist in collation of results in systematic review s and meta-analyses . Methods The objective of this review was to identify methods used to measure change in the clinical practice s of health professionals following an intervention aim ed at increasing the uptake of evidence into practice . All published trials included in a recent , comprehensive Health Technology Assessment of interventions to implement clinical practice guidelines and change clinical practice ( n = 228 ) formed the sample for this study . Using a st and ardised data extraction form , one review er ( SH ) , extracted the relevant information from the methods and /or results sections of the trials . Results Measures of a change of health practitioner behaviour were the most common , with 88.8 % of trials using these as outcome measures . Measures that assessed change at a patient level , either actual measures of change or surrogate measures of change , were used in 28.8 % and 36.7 % of studies ( respectively ) . Health practitioners ' knowledge and attitudes were assessed in 22.8 % of the studies and changes at an organisational level were assessed in 17.6 % . Conclusion Most trials of interventions aim ed at changing clinical practice measured the effect of the intervention at the level of the practitioner , i.e. did the practitioner change what they do , or has their knowledge of and /or attitude toward that practice changed ? Less than one-third of the trials measured , whether or not any change in practice , result ed in a change in the ultimate end-point of patient health status OBJECTIVES The aim of the present study was to estimate physician job satisfaction at the Mexican Institute of Social Security ( IMSS ) , the Ministry of Health ( SSA ) and in the private sector , and to measure the association between these different family medical care organization models . METHODS A comparative cross-sectional design was used to investigate the job satisfaction of family physicians in private and institutional family medicine clinics . Satisfaction was measured with a previously constructed and vali date d instrument . The instrument measures the satisfaction in four areas : ' global satisfaction ' , ' institution where the physician works ' , ' the patients ' and ' themselves as physicians ' . RESULTS One hundred and seven IMSS physicians , 106 SSA physicians and 97 private physicians were selected r and omly from a census according to the sample size . The sample was weighted . Fifty-one percent of IMSS and SSA physicians were dissatisfied , against 25 % in the private sector , in the first three areas . Comparing the private model and the IMSS , differences were found ( P < 0.0001 ) in the area of ' global satisfaction ' [ odds ratio ( OR ) = 2.47 , 95 % confidence interval ( CI ) 1.69 - 3.67 ] , ' institution where the physician works ' ( OR = 2.12 , CI 1 . 45 - 3.13 ) and ' themselves as physicians ' ( OR = 1.84 , CI 1.28 - 2.65 ) . When the private/SSA groups were compared , the differences were similar ( P < 0.0001 ) . No differences were found in terms of ' the patients ' . When stratifying , the risks increased in females , in the group aged 31 - 40 years and in specialists in family medicine . CONCLUSIONS The organization model is associated with dissatisfaction in all areas , except in ' the patients ' Abstract OBJECTIVE : To assess the association between  HMO practice  , time pressure , and physician job satisfaction . DESIGN : National r and om stratified sample of 5,704 primary care and specialty physicians in the United States . Surveys contained 150 items reflecting 10 facets ( components ) of satisfaction in addition to global satisfaction with current job , one ’s career and one ’s specialty . Linear regression-modeled satisfaction ( on 1–5 scale ) as a function of specialty , practice setting ( solo , small group , large group , academic , or HMO ) , gender , ethnicity , full-time versus part-time status , and time pressure during office visits . “ HMO physicians ” ( 9 % of total ) were those in group or staff model HMOs with > 50 % of patients capitated or in managed care . RESULTS : Of the 2,326 respondents , 735 ( 32 % ) were female , 607 ( 26 % ) were minority ( adjusted response rate 52 % ) . HMO physicians reported significantly higher satisfaction with autonomy and administrative issues when compared with other practice types ( moderate to large effect sizes ) . However , physicians in many other practice setting s averaged higher satisfaction than HMO physicians with re sources and relationships with staff and community ( small to moderate effect sizes ) . Small and large group practice and academic physicians had higher global job satisfaction scores than HMO physicians ( P<.05 ) , and private practice physicians had quarter to half the odds of HMO physicians of intending to leave their current practice within 2 years ( P<.05 ) . Time pressure detracted from satisfaction in 7 of 10 satisfaction facets ( P<.05 ) and from job , career , and specialty satisfaction ( P<.01 ) . Time allotted for new patients in HMOs ( 31 min ) was less than that allotted in solo ( 39 min ) and academic practice s ( 44 min ) , while 83 % of family physicians in HMOs felt they needed more time than allotted for new patients versus 54 % of family physicians in small group practice s ( P<.05 after Bonferroni ’s correction ) . CONCLUSIONS : HMO physicians are generally less satisfied with their jobs and more likely to intend to leave their practice s than physicians in many other practice setting s. Our data suggest that HMO physicians ’ satisfaction with staff , community , re sources , and the duration of new patients visits should be assessed and optimized . Whether providing more time for patient encounters would improve job satisfaction in HMOs or other practice setting s remains to be determined Objectives The goal of this study was to identify predictors of general and medication adherence in women with fibromyalgia ( FM ) . Methods Participants were 142 women recruited from tertiary care hospitals or the community and 10 rheumatologists . Participants ' demographic , clinical , and psychosocial characteristics , as well as patient – physician discordance , were assessed at the index visit . Adherence was assessed 6 months later . Multivariable generalized estimating equations were used to identify predictors of general adherence and adherence to medication . Results The average age of participants was 50.9 years ( SD=10.2 ) and the median duration of FM was 32 months . Participants reported extensive use of health services and medications . The mean score for general adherence was 61.0 ( SD=22.4 ; range 0–100 ) and 52.9 % of the cohort reported at least one form of behavior reflecting nonadherence to medications . More general adherence was significantly predicted by lower patient – physician discordance on patient well-being and lower patient psychological distress . Medication adherence was significantly predicted by higher affective pain and lower patient psychological distress . Conclusions Adherence is influenced by both clinical ( patient – physician discordance and pain ) and psychological ( distress ) factors in women with FM . Improvements in these domains may improve adherence in FM BACKGROUND Physician job satisfaction has been linked to various patient care and health system outcomes . A survey instrument that concisely measures physicians ' satisfaction with various job facets can help diverse stake-holders to better underst and and manage these outcomes . OBJECTIVE To document the development and validation of a multidimensional physician job satisfaction measure and separate global satisfaction measures . DESIGN Self-administered question naire :  Physician Worklife Survey ( PWS ) .  SUBJECTS A pilot study employed a national American Medical Association Masterfile sample of US primary care physicians and r and om sample s from four states . Responses ( n = 835 ; 55 % return rate ) were r and omly assigned to developmental ( n = 560 ) or cross-validation ( n = 275 ) sample s. A national sample ( n = 2,325 ; 52 % response rate ) of physicians was used in a subsequent validation study . RESULTS A 38-item , 10-facet satisfaction measure result ing from factor and reliability analyses of 70 pilot items was further reduced to 36 items . Reliabilities of the 10 facets ranged from .65 to .77 . Three scales measuring global job , career , and specialty satisfaction were also constructed with reliabilities from .84 to .88 . Results supported face , content , convergent , and discriminant validity of the measures . CONCLUSIONS Physician job satisfaction is a complex phenomenon that can be measured using the PWS Although variations in physicians ' practice patterns and use of re sources are well documented , the reasons for these variations are less well understood . The uncertainty inherent in patient care may be one explanation . Existing measures of intolerance to uncertainty , developed in context s outside of patient care , fail to explain these variations . To address this limitation , the Physicians ' Reactions to Uncertainty scale was developed . A question naire containing an initial pool of 61 items was mailed to a r and om sample of 700 physicians in North Carolina and Oregon , stratified by specialty . The items covered nine areas of physicians ' reactions to uncertainty derived from interviews with physicians and a definition of the concept affective reactions to uncertainty in patient care . Factor analysis of the 428 responses received yielded two primary factors that accounted for 58 % of the common variance among the 61 items . Items with unambiguous loadings on these factors defined two reliable and readily interpretable subscales : Stress from Uncertainty ( Cronbach 's alpha = 0.90 , 13 items ) and Reluctance to Disclose Uncertainty to Others ( alpha = 0.75 , 9 items ) . By virtue of its clarity and good psychometric properties , this new measure promises insights into the role that uncertainty plays in physicians ' re source utilization and practice patterns BACKGROUND Applied prospect ively to patients with peripheral arterial disease , individualized decision analysis has the potential to improve the surgeon 's ability to optimize patient outcome . METHODS A prospect i ve , r and omized trial comparing Markov surgical decision analysis to st and ard decision-making was performed in 206 patients with symptomatic lower extremity arterial disease .  Utility assessment and quality of life were determined from individual patients prior to treatment . Vascular surgeons provided estimates of  probability of treatment outcome , intended and actual treatment plans , and assessment of comfort with the decision ( PDPI )  . Treat 
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Conclusion This systematic review provides a critical appraisal and repository of instruments that assess the perception physicians have of the decision-making process within specific clinical encounters .