Journal of general internal medicine
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Among older adults with chronic kidney disease (CKD), the comparative event rates of end-stage renal disease (ESRD) and cause-specific death are unknown. ⋯ Older adults with CKD are 13-fold more likely to die from any cause than progress to ESRD and are 6-fold more likely to die from cardiovascular causes than develop ESRD.
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Comparative Study
Code status discussions between attending hospitalist physicians and medical patients at hospital admission.
Bioethicists and professional associations give specific recommendations for discussing cardiopulmonary resuscitation (CPR). ⋯ Code status was not discussed with many seriously ill patients. Discussions were brief, and did not include elements that bioethicists and professional associations recommend to promote patient autonomy. Local and national guidelines, research, and clinical practice changes are needed to clarify and systematize with whom and how CPR is discussed at hospital admission.
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Comparative Study
Pending laboratory tests and the hospital discharge summary in patients discharged to sub-acute care.
Previous studies have noted a high (41%) prevalence and poor discharge summary communication of pending laboratory (lab) tests at the time of hospital discharge for general medical patients. However, the prevalence and communication of pending labs within a high-risk population, specifically those patients discharged to sub-acute care (i.e., skilled nursing, rehabilitation, long-term care), remains unknown. ⋯ Approximately one-third of the sub-acute care patients in this study had labs pending at discharge, but few were documented within hospital discharge summaries. Even after considering the availability of preliminary microbiology results, these omissions remain common. Future studies should focus on improving the communication of pending lab tests at discharge and evaluating the impact that this improved communication has on patient outcomes.
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Randomized Controlled Trial Comparative Study
The impact of resident duty hour reform on hospital readmission rates among Medicare beneficiaries.
A key goal of resident duty hour reform by the Accreditation Council for Graduate Medical Education (ACGME) in 2003 was to improve patient outcomes. ⋯ Among Medicare beneficiaries, there were no changes in hospital readmission rates associated with resident duty hour reform.