Journal of general internal medicine
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Despite recent growth in palliative care programs palliative care remains underutilized. Studies suggest that patients and providers commonly associate palliative care with end of life, often leading to misconceptions and late referrals. ⋯ US adults who have some knowledge of palliative care are most likely to confuse it with hospice but are less likely to see it as requiring forgoing treatment or as giving up. Primary care clinicians should be encouraged to communicate about palliative care with patients.
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Big data promises to spark new discoveries but may also distort clinical research. Large datasets that permit numerous analyses could increase the number of spurious findings and threaten the reproducibility and validity of clinical research. The publication of unreproducible research is incentivized by a scientific culture that rewards novelty over rigor. ⋯ By enabling scientists to share preliminary work and publish evolving versions of manuscripts, preprints may also facilitate "workshopping" of ideas and detailed methodological review. This would better reflect the iterative nature of observational research than peer-reviewed publications, which immutably document the "final" results of a study. Preprint platforms are a timely innovation that may buffer the undesired effects of big data on clinical research.
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There has been a recent proliferation of consumer health devices (CHDs) that enable user-initiated screening for a variety of diseases. These devices represent a paradigm shift in the deployment of disease screening, a process that has historically been led by clinicians following the guidance of professional bodies. ⋯ However, as CHD technologies mature and become more affordable, they have the potential to detect actionable subclinical disease and improve health. Rather than allow CHDs to enter the marketplace organically with the potential for unintended negative consequences, it is critical that clinical, research, and industry communities proactively collaborate and establish best practices for their use.
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Observational Study
Underutilization of Portable Orders for Life-Sustaining Treatment at Discharge from Hospital: Observational Study at US Academic Trauma Center.
Decisions to limit use of life-sustaining treatment occur frequently during hospitalizations, and portable medical orders (also known as Portable Orders for Life-Sustaining Treatment (POLST)) can ensure that patient preferences regarding resuscitation are followed after discharge. ⋯ Despite primary hospital providers engaging in conversations regarding resuscitation and entering DNR orders during hospitalization, the majority of patients in our study discharged to other care facilities without POLST orders. POLST orders are a simple palliative care tool available to primary hospital providers to help ensure continuity of plan of care at discharge for patients who wish to avoid invasive life-sustaining treatments and/or cardiopulmonary resuscitation.