Journal of general internal medicine
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Randomized Controlled Trial
Comparison of Two Methods for Implementing Comfort Care Order Sets in the Inpatient Setting: a Cluster Randomized Trial.
There is an ongoing need for interventions to improve quality of end-of-life care for patients in inpatient settings. ⋯ Findings suggest the clinical effectiveness of palliative care educational intervention was not dependent on which of the two implementation methods was used.
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According to the American Association of Medical Colleges, women comprise 26% of full professors and 19% of medical school department chairs. African American and Latino faculty comprise 4.6% of full professors and 6.9% of department chairs. ⋯ We found that participant gender and race/ethnicity shaped perspectives of medical school faculty advancement in distinct ways.
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Moral distress is a state in which a clinician cannot act in accordance with their ethical beliefs because of external constraints. Physician trainees, who work within rigid hierarchies and who lack clinical experience, are particularly vulnerable to moral distress. We examined the dynamics of physician trainee moral distress in end-of-life care by comparing experiences in two different national cultures and healthcare systems. ⋯ This research highlights how the differing experiences of moral distress among US and UK physician trainees are influenced by their countries' healthcare cultures. This research illustrates how experiences of moral distress reflect the broader culture in which it occurs and suggests how trainees may be particularly vulnerable to it. Clinicians and healthcare leaders in both countries can learn from each other about policies and practices that might decrease the moral distress trainees experience.
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Randomized Controlled Trial
Hospital-Level Care at Home for Acutely Ill Adults: a Qualitative Evaluation of a Randomized Controlled Trial.
Substitutive hospital-level care in a patient's home ("home hospital") has been shown to lower cost, utilization, and readmission compared to traditional hospital care. However, patients' perspectives to help explain how and why interventions like home hospital accomplish many of these results are lacking. ⋯ Compared to control patients, home patients had better experiences with their care team, had more experiences promoting healing such as better sleep and physical activity, and had better experiences with systems factors such as the admission processes. Potential explanations include continuity of care, the power and familiarity of the home, and streamlined logistics. Future improvements include enhanced care transitions and ensuring digital interfaces are usable.