Journal of general internal medicine
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To determine which aspects of outpatient attending physician performance (e.g., clinical ability, teaching ability, interpersonal conduct) were measurable and separable by resident report. ⋯ Although this evaluation instrument for measuring clinic attending performance must be considered preliminary, this study suggests that relatively few attending evaluations are required to reliably profile an individual attending's performance, that attending identity is associated with a large amount of the scale score variation, and that special issues of attending performance more relevant to the outpatient setting than the inpatient setting (availability in clinic and sensitivity to time efficiency) should be considered when evaluating clinic attending performance.
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To describe how medical residents discuss do-not-resuscitate (DNR) orders with patients. ⋯ Medical ethicists, professional societies, and the public recommend more frequent discussions about DNR orders. Even when housestaff discuss resuscitation with patients, they may not be accomplishing the goal of increasing patient autonomy. Research and education must focus on improving the quality, as well as the quantity, of these discussions.
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Multicenter Study Comparative Study
Comparison of a disease-specific and a generic severity of illness measure for patients with community-acquired pneumonia.
To compare the performances of a disease-specific severity of illness index and a prototypical generic severity of illness measure, MedisGroups Admission Severity Groups (ASGs), for patients with community-acquired pneumonia. ⋯ The PSI provided more accurate estimates of hospital mortality and classified different hospital outliers for mortality than did the generic severity of illness measure for patients with community-acquired pneumonia.
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Patients who leave hospitals against medical advice (AMA) frustrate physicians and may put themselves at medical risk. A case-control study was conducted to characterize the factors associated with AMA discharges from an impatient medical service. ⋯ The patients most often stated that they were leaving because they "felt better" or had personal or financial obligations. However, the patients leaving AMA were more likely to return for care within the next week than were the control patients.