Journal of general internal medicine
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History has demonstrated cyclical trends in opioid use in the USA, alternating between high rates of prescribing driven by compassion and marketing and restrictive prescribing driven by stigma and fear of precipitating addiction and other harms. Two under-recognized yet powerful forces driving these trends are societal biases against individuals who use and are addicted to drugs, as well as a recognized social determinant of health, institutional discrimination. ⋯ To do so, we highlight ways to prevent racist and classist ideologies from further shaping responses towards opioid use. It is important to acknowledge the long history that has influenced responses to opioid use in the USA and take active steps towards promoting a sense of compassion towards all individuals who use and those who are addicted to drugs.
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Randomized Controlled Trial
Effect of Outpatient Note Templates on Note Quality: NOTE (Notation Optimization through Template Engineering) Randomized Clinical Trial.
This is the first randomized controlled trial evaluating the impact of note template design on note quality using a simulated patient encounter and a validated assessment tool. ⋯ Residents rated the new note template more visually appealing, shorter, and less cluttered. Faculty reviewers rated both note types equivalent in the overall quality but rated new notes inferior in terms of accuracy and usefulness though better organized. This study demonstrates a novel method of a simulated clinical encounter to evaluate note templates before the introduction into practice.
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Randomized Controlled Trial
Substance Use Disorder Detection Rates Among Providers of General Medical Inpatients.
The prevalence of substance use disorders is higher among medical inpatients than in the general population, placing inpatient providers in a prime position to detect these patients and intervene. ⋯ Findings indicate patient characteristics, including gender, race, and addiction severity impact rates of provider detection. Instituting formal screening for all substances may increase provider detection and inform treatment decisions.
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Administrative data algorithms (ADAs) to identify pneumonia cases are commonly used in the analysis of pneumonia burden, trends, etiology, processes of care, outcomes, health care utilization, cost, and response to preventative and therapeutic interventions. However, without a good understanding of the validity of ADAs for pneumonia case identification, an adequate appreciation of this literature is difficult. We systematically reviewed the quality and accuracy of published ADAs to identify adult hospitalized pneumonia cases. ⋯ ADAs for identification of adult pneumonia hospitalizations are highly heterogeneous, poorly validated, and at risk for misclassification bias. Greater standardization in reporting ADA accuracy is required in studies using pneumonia ADA for case identification so that results can be properly interpreted.