Journal of general internal medicine
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Multicenter Study
Sins of omission: getting too little medical care may be the greatest threat to patient safety.
Little is known about the relative incidence of serious errors of omission versus errors of commission. ⋯ While preventing iatrogenic injury resulting from medical errors is a critically important part of quality improvement, we found that the overwhelming majority of substantive medical errors identifiable from the medical record were related to people getting too little medical care, especially for those with chronic medical conditions.
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The impact of national efforts to limit antibiotic prescribing has not been fully evaluated. ⋯ During the study period, outpatient antibiotic prescribing for respiratory infections where antibiotics are rarely indicated has declined, while the proportion of broad-spectrum antibiotics prescribed for these diagnoses has increased significantly. This trend resulted in a 15% decline in the total proportion of outpatient visits in which antibiotics were prescribed. However, because outpatient visits increased 17% over this time period, the population burden of outpatient antibiotic prescriptions changed little.
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Randomized Controlled Trial
A randomized-controlled study of encounter cards to improve oral case presentation skills of medical students.
To determine the feasibility of oral case presentation (OCP) encounter cards as a tool for formative evaluation, to estimate the reliability and validity of the ratings when used in a medicine clerkship, and to examine whether the use of OCP encounter cards improves students' OCP skills. ⋯ OCP encounter cards are a novel and feasible tool to assess clerkship students' oral case presentation skills. OCP card ratings are reproducible, and validity is suggested by their correlation with multiple markers of performance. However, encounter cards did not improve performance on summative oral presentations.
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The reliance on physical examination as a diagnostic aid is in decline. ⋯ A skills improvement program can significantly increase the frequency of physical examination, but teaching and feedback events remain sporadic and infrequent.
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Little guidance is available for health care providers who try to communicate with patients and their families in a culturally sensitive way about end-of-life care. ⋯ The groups differed broadly in their preferences for both the content and structure of end-of-life discussions and on the values that influence those preferences. Further research is necessary to help practitioners engage in culturally sensitive end-of-life discussions with patients and their families by considering varying preferences for the goals of end-of-life care communication.