JAMA internal medicine
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JAMA internal medicine · Mar 2020
Professional Dissonance and Burnout in Primary Care: A Qualitative Study.
Burnout negatively affects physician health, productivity, and patient care. Its prevalence is high among physicians, especially those in primary care, yet few qualitative studies of burnout have been performed that engage frontline primary care practitioners (PCPs) for their perspectives. ⋯ In sharing their perspectives on factors contributing to burnout, frontline PCPs interviewed during this study described dissonance between their professional values and the realities of primary care practice, an authority-responsibility mismatch, and a sense of undervaluation. Practitioners also identified possible solutions institutions might consider investing in to resolve professional dissonance, reduce burnout rates, and improve professional fulfillment.
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JAMA internal medicine · Mar 2020
Mortality Trends for Veterans Hospitalized With Heart Failure and Pneumonia Using Claims-Based vs Clinical Risk-Adjustment Variables.
Prior studies have reported declines in mortality for patients admitted to Veterans Health Administration (VA) and non-VA hospitals using claims-based risk adjustment. These apparent mortality reductions may be influenced by changes in coding practices. ⋯ Among HF and pneumonia hospitalizations, adjusting for clinical covariates attenuated declines in mortality rates identified using claims-based models. Assessments of temporal trends in 30-day mortality using claims-based risk adjustment should be interpreted with caution.
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JAMA internal medicine · Feb 2020
Association of the Work Schedules of Hospitalists With Patient Outcomes of Hospitalization.
The working schedules of hospitalists vary widely. Discontinuous schedules, such as 24 hours on and 48 hours off, result in several hospitalists providing care during a patient's hospital stay. Poor continuity of care during hospitalization may be associated with poor patient outcomes. ⋯ Hospitalist schedules vary widely. Admitted patients receiving care from hospitalists with schedules that promote inpatient continuity of care may experience better outcomes of hospitalization.
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JAMA internal medicine · Feb 2020
ReviewEvaluation of the Extended-Release/Long-Acting Opioid Prescribing Risk Evaluation and Mitigation Strategy Program by the US Food and Drug Administration: A Review.
Extended-release/long-acting (ER/LA) opioids have caused substantial morbidity and mortality in the United States, yet little is known about the efforts of the US Food and Drug Administration (FDA) and drug manufacturers to reduce adverse outcomes associated with inappropriate prescribing or use. This review of 9739 pages of FDA documents obtained through a Freedom of Information Act request aimed to investigate whether the FDA and ER/LA manufacturers were able to assess the effectiveness of the ER/LA Risk Evaluation and Mitigation Strategy (REMS) program by evaluating manufacturer REMS assessments and FDA oversight of these assessments. ⋯ Five years after initiation, the FDA and ER/LA manufacturers could not conclude whether the ER/LA REMS had reduced inappropriate prescribing or improved patient outcomes. Alternative observational study designs would have allowed for more rigorous estimates of the program's effectiveness.
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JAMA internal medicine · Feb 2020
Randomized Controlled Trial Multicenter StudyAcyclovir for Mechanically Ventilated Patients With Herpes Simplex Virus Oropharyngeal Reactivation: A Randomized Clinical Trial.
The role of herpes simplex virus (HSV) reactivation on morbidity and mortality in patients in the intensive care unit requiring mechanical ventilation remains unknown. ⋯ In patients receiving mechanical ventilation for 96 hours or more with HSV reactivation in the throat, use of acyclovir, 5 mg/kg, 3 times daily for 14 days, did not increase the number of ventilator-free days at day 60, compared with placebo. These findings do not appear to support routine preemptive use of acyclovir in this setting.