Journal of general internal medicine
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Observational analysis methods can be refined by benchmarking against randomized trials. We reviewed studies systematically comparing observational analyses using propensity score methods against randomized trials to explore whether intervention or outcome characteristics predict agreement between designs. ⋯ Disagreements between observational studies using propensity score methods and randomized trials can occur for many reasons and the available data cannot be used to discern the reasons behind specific disagreements. Better benchmarking of observational analyses using propensity scores (and other causal inference methods) is possible using observational studies that explicitly attempt to emulate target trials.
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When working with surrogate decision-makers, physicians often encounter ethical challenges that may cause moral distress which can have negative consequences for physicians. ⋯ Physician moral distress occurs more frequently when the physician is male, the patient is older or requires decisions about life-sustaining treatments. These findings may help target interventions to support physicians. Prior discussions about patient wishes is associated with lower distress and may be a target for patient-centered interventions.
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Randomized Controlled Trial
Short-Term VA Health Care Expenditures Following a Health Risk Assessment and Coaching Trial.
Short-term health care costs following completion of health risk assessments and coaching programs in the VA have not been assessed. ⋯ Compared to completing and receiving HRA results, working with health coaches to set actionable health behavior change goals following HRA completion did not reduce short-term health expenditures.
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Heterogeneity of existing physician burnout studies impairs analyses of longitudinal trends, geographic distribution, and organizational factors impacting physician burnout. The Department of Veterans Affairs (VA) is one of the largest integrated healthcare systems in the USA, offering a unique opportunity to study burnout across VA sites and time. ⋯ VA physician burnout was lower than previously described in many non-VA studies and was relatively stable over time. These findings may be due to unique characteristics of the VA practice environment. Nonetheless, with over a third of VA physicians reporting burnout, organizational interventions are needed. Primary care physicians and those practicing at small, rural sites have higher rates of burnout and may warrant more focused attention. Our results can guide targeted interventions to promote VA physician well-being and inform efforts to address burnout in diverse clinical settings.
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In late December 2019, a cluster of cases with 2019 Novel Coronavirus pneumonia (SARS-CoV-2) in Wuhan, China, aroused worldwide concern. Previous studies have reported epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19). The purpose of this brief review is to summarize those published studies as of late February 2020 on the clinical features, symptoms, complications, and treatments of COVID-19 and help provide guidance for frontline medical staff in the clinical management of this outbreak.