Journal of general internal medicine
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Approximately 25 million people in the USA are limited English proficient (LEP). When LEP patients receive care from physicians who are truly language concordant, some evidence show that language disparities are reduced, but others demonstrate worse outcomes. We conducted a systematic review of the literature to compare the impact of language-concordant care for LEP patients with that of other interventions, including professional and ad hoc interpreters. ⋯ The findings of this review indicate that, in the majority of situations, language-concordant care improves outcomes. Although most studies included were of good quality, none provided a standardized assessment of provider language skills. To systematically evaluate the impact of truly language-concordant care on outcomes and draw meaningful conclusions, future studies must include an assessment of clinician language proficiency. Language-concordant care offers an important way for physicians to meet the unique needs of their LEP patients.
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Doctors' burnout is a major public health issue with important harmful effects on both the healthcare system and physicians' mental health. Qualitative studies are relevant in this context, focusing as they do on the views of the physicians of how they live and understand burnout in their own professional field. ⋯ The individual and organizational levels are abundantly described in the literature, as risk factors and interventions. Our results show that doctors identify numerous organizational factors as originators of potential burnout, but envision protecting themselves individually. Relational factors, in a mediate position, should be addressed as an original axis of protection and intervention for battling doctors' burnout.
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Meta Analysis
Postponement of Death by Statin Use: a Systematic Review and Meta-analysis of Randomized Clinical Trials.
The average postponement of the outcome (gain in time to event) has been proposed as a measure to convey the effect of preventive medications. Among its advantages over number needed to treat and relative risk reduction is a better intuitive understanding among lay persons. ⋯ The systematic review was registered in PROSPERO [CRD42016037507] .
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Urinary incontinence (UI) is a common malady in women. Numerous nonsurgical treatments are available, each associated with risk of adverse events (AEs). ⋯ Behavioral therapies and neuromodulation have low risk of AEs. Anticholinergics and alpha agonists have high rates of dry mouth and constitutional effects. BTX is associated with UTIs and voiding dysfunction. Periurethral bulking agents are associated with erosion and voiding dysfunction. These AEs should be considered when selecting appropriate UI treatment options. AE reporting is inconsistent and AE rates across studies tended to vary widely. Trials should report AEs more consistently.
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Clinical reasoning is a core component of clinical competency that is used in all patient encounters from simple to complex presentations. It involves synthesis of myriad clinical and investigative data, to generate and prioritize an appropriate differential diagnosis and inform safe and targeted management plans. The literature is rich with proposed methods to teach this critical skill to trainees of all levels. ⋯ In this perspective, we first introduce the concepts of illness scripts and dual-process theory that describe the roles of analytic system 1 and non-analytic system 2 reasoning in clinical decision making. Thereafter, we draw upon existing evidence and expert opinion to review a range of methods that allow for effective assessment of clinical reasoning, contextualized within Miller's pyramid of learner assessment. Key assessment strategies that allow teachers to evaluate their learners' clinical reasoning ability are described from the level of knowledge acquisition, through to real-world demonstration in the clinical workplace.