Journal of general internal medicine
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Evidence for the benefit of implantable cardioverter defibrillators (ICD) in preventing sudden cardiac death (SCD) in older adults is mixed; age alone may not predict benefit. Frailty may help identify patients in whom an ICD does not improve overall mortality risk. ⋯ Existing literature suggests that individuals with frailty may not benefit from ICD placement for primary prevention of SCD.
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Routine population-based screening for depression is an essential part of evolving health care models integrating care for mental health in primary care. Depression instruments often include questions about suicidal thoughts, but how patients experience these questions in primary care is not known and may have implications for accurate identification of patients at risk. ⋯ All participants believed being asked questions about suicidal thoughts was appropriate, though some who disclosed suicidal thoughts described experiencing stigma and sometimes distanced themselves from suicidality. Direct communication with trusted providers, who listened and expressed empathy, bolstered comfort with disclosure. Future research should consider strategies for reducing stigma and encouraging fearless disclosure among primary care patients experiencing suicidality.
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Measuring care coordination in administrative data facilitates important research to improve care quality. ⋯ Many features of shared patient networks constructed from a single-payer database differed from similar networks constructed from other payers' data. Depending on a study's goals, shortcomings of single-payer networks should be considered when using claims data to draw conclusions about provider behavior.
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The use of medications not relieving symptoms or maximizing quality of life should be minimized following hospice enrollment. ⋯ A substantial proportion of Medicare hospice beneficiaries continued to receive LBMs following hospice enrollment. Providers should evaluate the necessity of continuing non-palliative medications at the end of life through a careful, patient-centric consideration of their potential risks and benefits.
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Mentoring's success has been attributed to individualised matching, holistic mentoring relationships (MRs) and personalised mentoring environments (MEs). Whilst there is growing data on matching and MRs, a dearth of ME data has hindered development of mentoring programme. Inspired by studies likening MEs to learning environments (LEs) and data highlighting common characteristics between the two, this systematic review scrutinises reports on LEs to extrapolate the findings to the ME context to provide a better understanding of ME and their role in the mentoring process. ⋯ LE is the product of culture and structure that influence and are influenced by the tutor-learner-host organisation relationship. LE structure guides the evolving tutor-learner-host organisation relationship whilst the LE culture nurtures it and oversees the LE structure. Similarities between LEs and MEs allow LE data to inform programme designers of ME's role in mentoring's success.