Journal of general internal medicine
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Racial/ethnic disparities in anticoagulation management are well established. Differences in warfarin monitoring can contribute to these disparities and should be measured. ⋯ We did not find a race/ethnicity nor language disparity in INR monitoring; safety-net site was the main source of variation.
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Anticoagulation poses unique challenges for women of reproductive age. Clinicians prescribing anticoagulants must counsel patients on issues ranging from menstruation and the possibility of developing a hemorrhagic ovarian cyst to teratogenic risks and safety with breastfeeding. Abnormal uterine bleeding affects up to 70% of young women who are treated with anticoagulation. ⋯ During pregnancy, enoxaparin remains the preferred anticoagulant and warfarin is contraindicated. Breastfeeding women may use warfarin, but direct oral anticoagulants are not recommended given their limited safety data. This practical guide for clinicians is designed to inform discussions of risks and benefits of anticoagulation therapy for women of reproductive age.
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The coronavirus disease (COVID)-19 pandemic continues to have an impact on health care. A potential new wave can be foreseen concerning the impact of the pandemic on medical research and literature. ⋯ This occurred at the expense of non-COVID-19-related scientific papers as most journals did not increase the total number of their published articles. Thus, our analysis may outlook a new potential scientific wave related to COVID-19, in addition to the clinical ones, possibly delaying the improvement in the quality of care for other diseases in the next years.
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Spousal death is associated with elevated mortality in the surviving partner; less is known about how healthcare costs and use change following spousal death. ⋯ Spousal death increased total Medicare costs and use of all healthcare categories among the surviving partner; elevations in hospitalization and sub-acute care persisted through the third year. Clinicians and payors may want to target surviving partners as a high-risk population.
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Observational Study
The Relationship Between Governing Board Composition and Medicare Shared Savings Program Accountable Care Organizations Outcomes: an Observational Study.
Early studies of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) suggested that physician leadership was an important driver of ACO success, but it is unknown whether the demographic and professional composition of current MSSP ACO governing boards is associated with ACOs' publicly reported outcomes. ⋯ MSSP ACO governing boards were predominately male and physician-led. Physician involvement may be important for achieving quality goals, while lack of female involvement showcases an opportunity to diversify boards.