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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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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Comparative Study
Self-reported comorbidities, perceived needs, and sources for usual care for older and younger homeless adults.
While older individuals who are homeless tend to be in poorer health, it is less clear how they view their health care needs and whether their self-reported patterns for accessing health services differ from younger homeless counterparts. ⋯ Older homeless adults have a greater disease burden than their younger counterparts. However, it is unclear whether these needs are being appropriately identified and met. There is a need for specific and targeted outreach to connect them to appropriate services.
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Hepatitis C virus (HCV) infection is both prevalent and undertreated. ⋯ HCV treatment was infrequent in our cohort of outpatients. Barriers to treatment included patient factors (patient preference, alcohol use, missed appointments), provider factors (reluctance to treat past substance abusers), and system factors (referral-associated delays). Multimodal interventions may be required to increase HCV treatment rates.
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Few recent studies have reported data on the incidence of herpes zoster (HZ) in U.S. general clinical practice. ⋯ The overall incidence of HZ reported in the present study was found to be similar to rates observed in U.S. analyses conducted 10 to 20 years earlier, after age- and sex-standardizing estimates from all studies to the 2000 U.S. population. The higher rate of HZ in females compared with males contrasts with prior U.S. studies.