Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Thoracentesis has been identified as a core competency for hospitalists. Residency training may not provide adequate preparation to perform this procedure. ⋯ A curriculum featuring deliberate practice dramatically increased the skills of residents in thoracentesis. Residents enjoy training and receiving evaluation and feedback in a simulated clinical environment. This mastery program illustrates a feasible and reliable mechanism to achieve procedural competency.
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Postdischarge follow-up visits for medical and pharmacy students on an inpatient medicine clerkship.
Teaching medical and pharmacy students to collaborate on discharge planning for chronically ill patients may facilitate their ability to provide quality care. ⋯ A clinically oriented curriculum with postdischarge visits improved students' attitudes and self-assessed skills in interdisciplinary collaboration and transitional care and fostered a patient-centered approach to care.
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Clinical hospital medicine fellowships could accelerate the acquisition of increasingly demanding skills while enhancing esteem among subspecialty peers. We sought to determine whether medicine residents perceived such fellowships as relevant and would be willing to forgo substantial income during the training period, in the context of the perspectives of employers and practicing hospitalists. ⋯ This study reveals a potentially unmet demand for clinical hospital medicine fellowship training. Further determination of need and related curricular development could be addressed under the leadership of national hospital medicine educational organizations.
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Review Meta Analysis Comparative Study
Effects of rapid response systems on clinical outcomes: systematic review and meta-analysis.
A rapid response system (RRS) consists of providers who immediately assess and treat unstable hospitalized patients. Examples include medical emergency teams and rapid response teams. Early reports of major improvements in patient outcomes led to widespread utilization of RRSs, despite the negative results of a subsequent cluster-randomized trial. ⋯ Published studies of RRSs have not found consistent improvement in clinical outcomes and have been of poor methodological quality. The positive results of before-after trials likely reflects secular trends and biased outcome ascertainment, as the improved outcomes they reported were of similar magnitude to those of the control group in the RCT. The effectiveness of the RRS concept remains unproven.
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Randomized Controlled Trial Comparative Study
A randomized clinical trial to compare the use of safety net enclosures with standard restraints in agitated hospitalized patients.
Although hospitals attempt to minimize the use of restraints, certain cases require their application. For such patients, there is a need for novel, safe and more humane restraint systems. ⋯ For hospitalized patients requiring restraint, the SOMA Safe Enclosure is effective and more acceptable to relatives, physicians, and secondary nurses than currently used restraints.