Journal of general internal medicine
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Randomized Controlled Trial Comparative Study
The impact of resident duty hour reform on hospital readmission rates among Medicare beneficiaries.
A key goal of resident duty hour reform by the Accreditation Council for Graduate Medical Education (ACGME) in 2003 was to improve patient outcomes. ⋯ Among Medicare beneficiaries, there were no changes in hospital readmission rates associated with resident duty hour reform.
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Comparative Study
Primary care providers’ judgments of opioid analgesic misuse in a community-based cohort of HIV-infected indigent adults.
Primary care providers (PCPs) must balance treatment of chronic non-cancer pain with opioid analgesics with concerns about opioid misuse. ⋯ PCPs’ impressions of misuse were discordant with patients’ self-reports of opioid analgesic misuse. PCPs incorrectly used age and race as predictors of misuse in this high-risk cohort.
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Among older adults with chronic kidney disease (CKD), the comparative event rates of end-stage renal disease (ESRD) and cause-specific death are unknown. ⋯ Older adults with CKD are 13-fold more likely to die from any cause than progress to ESRD and are 6-fold more likely to die from cardiovascular causes than develop ESRD.
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Systematic reviews have the potential to inform clinical decisions, yet little is known about the impact of interventions on increasing the use of systematic reviews in clinical decision-making. ⋯ The limited empirical data render the strength of evidence weak for the effectiveness and types of interventions that encourage clinicians to use systematic reviews in clinical decision making.
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Comparative Study
Code status discussions between attending hospitalist physicians and medical patients at hospital admission.
Bioethicists and professional associations give specific recommendations for discussing cardiopulmonary resuscitation (CPR). ⋯ Code status was not discussed with many seriously ill patients. Discussions were brief, and did not include elements that bioethicists and professional associations recommend to promote patient autonomy. Local and national guidelines, research, and clinical practice changes are needed to clarify and systematize with whom and how CPR is discussed at hospital admission.