Archives of internal medicine
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Comparative Study
Prescription errors and outcomes related to inconsistent information transmitted through computerized order entry: a prospective study.
Although several types of computerized provider order entry (CPOE)-related errors may occur, errors related to inconsistent information within the same prescription (ie, mismatch between the structured template and the associated free-text field) have not been described, to our knowledge. We determined the nature and frequency of such errors and identified their potential predictive variables. ⋯ Despite standardization of data entry, inconsistent communication in CPOE poses a significant risk to safety. Improving the usability of the CPOE interface and integrating it with workflow may reduce this risk.
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Comparative Study
Discussions with physicians about hospice among patients with metastatic lung cancer.
Many terminally ill patients enroll in hospice only in the final days before death or not at all. Discussing hospice with a health care provider could increase awareness of hospice and possibly result in earlier use. ⋯ Many patients diagnosed as having metastatic lung cancer had not discussed hospice with a provider within 4 to 7 months after diagnosis. Increased communication with physicians could address patients' lack of awareness about hospice and misunderstandings about prognosis.
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Extensive literature documents personal distress among physicians and a decrease in their satisfaction with the practice of medicine over recent years. We hypothesized that physicians who spent more of their time in the aspect of work that they found most meaningful would have a lower risk of burnout. ⋯ The extent to which faculty physicians are able to focus on the aspect of work that is most meaningful to them has a strong inverse relationship to their risk of burnout. Efforts to optimize career fit may promote physician satisfaction and help to reduce attrition among academic faculty physicians.
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Randomized Controlled Trial
A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain.
Acupuncture is a popular complementary and alternative treatment for chronic back pain. Recent European trials suggest similar short-term benefits from real and sham acupuncture needling. This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain. ⋯ Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture's purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects.