Journal of general internal medicine
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Multicenter Study Comparative Study
Circumstances Surrounding High-risk Sexual Experiences Among Primary Care Patients Living With and Without HIV.
Rates of sexually transmitted infection (STI) are rising in the USA, yet STI risk remains under-addressed by providers, even in HIV care, and with high-risk patients. We interviewed primary care patients living with and without HIV regarding circumstances surrounding sexual risk behavior to identify opportunities for providers to address and reduce STI risk. ⋯ Circumstances surrounding perceived STI exposure risk were diverse, often overlapping, and dependent on internal, environmental, and partner-related factors and inadequate communication. Meaningful care-based interventions regarding HIV/STI transmission behavior must address the diversity and interplay of these factors.
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Patients' comprehension of their medical conditions is fundamental to patient-centered care. Hospitalizations present opportunities to educate patients but also challenges to patient comprehension given the complexity and rapid pace of clinical care. We conducted a systematic review of the literature to characterize the current state of inpatients' knowledge of their hospitalization, assess the methods used to determine patient comprehension, and appraise the effects of interventions on improving knowledge. ⋯ Clinicians should be aware that comprehension is often poor among hospitalized patients, especially in those with lower education and advanced age. Our results are limited by overall poor quality of interventional studies. Future research should use objective, standardized measures of patient comprehension and interventions should be multifaceted in approach, focusing on knowledge improvement while also addressing other factors influencing outcomes.
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Burnout among primary care physicians, advanced practice clinicians (nurse practitioners and physician assistants [APCs]), and staff is common and associated with negative consequences for patient care, but the association of burnout with characteristics of primary care practices is unknown. ⋯ Burnout is prevalent among physicians, APCs, and staff in smaller primary care practices. Members of solo practices less commonly report burnout, while members of health system-owned practices and Federally Qualified Health Centers more commonly report burnout, suggesting that practice level autonomy may be a critical determinant of burnout.
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Observational Study
Insurance Coverage Predicts Mortality in Patients Transferred Between Hospitals: a Cross-Sectional Study.
Patients transferred between hospitals are at high risk of adverse events and mortality. The relationship between insurance status, transfer practices, and outcomes has not been definitively characterized. ⋯ Uninsured patients are more likely to be transferred from an ED and have higher mortality. These data suggest factors that drive inter-hospital transfer of uninsured patients have the potential to exacerbate outcome disparities.
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Historical Article
The Art of Observation and the Observation of Art: Zadig in the Twenty-first Century.
Astute observation is a fundamental component of the art of medicine. Yet most schools and residencies offer little formal teaching of this skill, with some outsourcing the entire subject matter to art museums and instructors. ⋯ To this end, we shall revisit both the method of Zadig, which William Osler practiced and taught to his students, and its application to the observation of art first pioneered by the Italian physician Giovanni Morelli. As an example of this skill, we shall use focused observation to decode a fifteenth century portrait that hangs at the Philadelphia Museum of Art, thus turning a seemingly non-descript Renaissance painting into a treasure trove of personal, social, and medical information.