Journal of general internal medicine
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Review Meta Analysis
Midodrine for orthostatic hypotension: a systematic review and meta-analysis of clinical trials.
To perform a systematic review and meta-analysis of clinical trials evaluating the efficacy and safety of midodrine in orthostatic hypotension (OH). ⋯ There is insufficient and low quality evidence to support the use of midodrine for OH.
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Clinical Trial
Implementing smoking cessation guidelines for hospitalized veterans: effects on nurse attitudes and performance.
A minority of hospitalized smokers actually receives assistance in quitting during hospitalization or cessation counseling following discharge. This study aims to determine the impact of a guideline-based intervention on 1) nurses' delivery of the 5A's (Ask-Advise-Assess-Assist-Arrange follow-up) in hospitalized smokers, and 2) nurses' attitudes toward the intervention. ⋯ A multifaceted intervention including academic detailing and adaptation of the nursing admission template is an effective strategy for improving nurses' delivery of brief cessation counseling in medical inpatients.
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Shared decision making improves value-concordant decision-making around prostate cancer screening (PrCS). Yet, PrCS discussions remain complex, challenging and often emotional for physicians and average-risk men. ⋯ Conference outcomes present an expert consensus of strategies likely to improve value-concordant prostate cancer screening decisions. In addition, the methodology used to obtain agreement provides a model of successful collaboration around this and future controversial cancer screening issues, which may be of interest to funding agencies, educators and policy makers.
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Teamwork is critical to providing excellent healthcare, and effective communication is essential for teamwork. Physicians often discuss patient referrals from other physicians, including referrals from outside their primary institution. Sharing conflicting information or negative judgments of other physicians to patients may be unprofessional. Poor teamwork within healthcare systems has been associated with patient mortality and lower staff well-being. ⋯ This study described comments by physicians criticizing other physicians to patients. This behavior may affect patient satisfaction and quality of care. Healthcare system policies and training should discourage this behavior.
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Studies of dermatologic inpatients are important, given the rise in the number of admissions and of Medicare spending for dermatology-specific and dermatology-related diagnosis related groups (DRGs) in recent years. Yet inpatient studies of patients admitted for skin conditions have mainly focused on dermatology consults, which neglect the experiences of patients not seen by dermatology. Identifying patients based on DRG codes includes all patients admitted for skin conditions and therefore allows for a more comprehensive analysis of the dermatologic care delivered. ⋯ Dermatologists were often not consulted for the care of patients with dermatology-related DRGs. When dermatologists were consulted, we found an impact on both diagnosis and management.