JAMA network open
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Although hospice use is increasing and patients in the US are increasingly dying at home, racial disparities in treatment intensity at the end of life, including hospice use, remain. ⋯ Despite the increase in the use of hospice care in recent decades, racial disparities in the use of hospice remain, especially for noncancer deaths. More research is required to better understand racial disparities in access to and quality of end-of-life care.
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Whether the cardiopulmonary resuscitation (CPR) preferences of patients receiving dialysis align with their values and other aspects of end-of-life care is not known. ⋯ The CPR preferences of patients receiving dialysis were associated with some, but not all, other aspects of end-of-life care. How participants responded to questions about these other aspects of end-of-life care were not always aligned with their CPR preference. More work is needed to integrate discussions about code status with bigger picture conversations about patients' values, goals, and preferences for end-of-life care.
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Medications for opioid use disorder, including buprenorphine hydrochloride and methadone hydrochloride, are highly effective at improving outcomes for individuals with the disorder. For pregnant women, use of these medications also improves pregnancy outcomes, including the risk of preterm birth. Despite the known benefits of medications for opioid use disorder, many pregnant and nonpregnant women with the disorder are not receiving them. ⋯ In this cross-sectional study with random assignment of clinicians and simulated-patient callers, many women, especially pregnant women, faced barriers to accessing treatment. Given the high out-of-pocket costs and lack of acceptance of insurance among many clinicians, access to affordable opioid use disorder treatment is a significant concern.
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The outcomes of surgical treatment in patients with intertrochanteric hip fractures are unsatisfactory. Computer-assisted virtual preoperative planning may provide an opportunity to solve this treatment dilemma. Virtual preoperative planning is a technique based on dynamic 3-dimensional computed tomographic imaging, which allows precise evaluation of fracture details and simulation of reduction of fracture and internal fixation procedures before surgery is performed. ⋯ Among older patients with intertrochanteric hip fractures, computer-assisted virtual preoperative planning was associated with decreases in the risks of all-cause 90-day mortality, postoperative complications, and reoperations compared with conventional preoperative planning.
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Observational Study
Assessment of Costs of Avoidable Delays in Intensive Care Unit Discharge.
Delays in transfer for discharge-ready patients from the intensive care unit (ICU) are increasingly described and contribute to strained capacity. ⋯ In this study, potentially avoidable discharge delay occurred for most patients admitted to ICUs across a large integrated health system and translated into substantial associated health care costs.