Journal of general internal medicine
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Given the reduced immune response to vaccines in older populations, this study aimed to evaluate the efficacy of COVID-19 vaccinations and its impact on breakthrough infection, hospital admission, and mortality in the elderly. ⋯ Our pooled results showed that SARS-CoV-2 vaccines administered to the elderly is effective in preventing prevent breakthrough infection, hospitalization, severity, and death. What's more, increasing number of vaccine doses is becoming increasingly effective.
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Prescription opioids were a major initial driver of the opioid crisis. States have attempted to reduce overprescribing by enacting policies that limit opioid prescriptions, but the impacts of such policies on new prescribing and subsequent transitions to long-term use are not fully understood. ⋯ The New Jersey policy was associated with a reduction in initial prescriptions with >5 days' supply, but not with an overall decline in new opioid prescriptions or in the rate at which initial prescriptions led to long-term use. Given their only modest benefits, policymakers and clinicians should carefully weigh potential unintended consequences of strict prescribing limits.
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The emergence of narrative medicine has promoted reflective practices and story-telling as means of promoting compassion, building resiliency, and understanding the "patient" and "physician" as "persons." However, though some narrative medicine pieces describe patients' experiences, the narrative of the patient is usually told by physicians, producing a second-hand facsimile of the patient's lived experience. Stories written by physicians may have their roots in patient encounters, but are filtered through the physician's, rather than the patient's, understanding of the world. ⋯ This paper explores the ways in which well-meaning physicians aiming to elevate patients' stories frequently fall short, and what we can do to better elevate patients' voices on the wards, in clinics, and in the medical literature. Stories about patients are important to help clinicians and trainees develop and practice compassionate person-centered care; stories written by patients on topics and with orientations of their choosing are currently lacking, and, we argue, even more important.
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Observational Study
U.S. Hospitals' Administrative Expenses Increased Sharply During COVID-19.
In response to the declining utilization and patient revenue due to the COVID-19 pandemic, the U.S. hospital industry furloughed at least 1.4 million health care workers to contain their clinical-related expenses. However, it remains unclear how hospitals responded by adjusting their administrative expenses, which account for more than a quarter of U.S. hospitals' spending, a proportion substantially higher than that of other industrialized countries. Examining changes in hospitals' administrative expenses during the COVID-19 pandemic is important for understanding hospitals' cost-containment behaviors under operational shocks during a pandemic. ⋯ In 2020, administrative expenses grew much faster than clinical expenses, resulting in a larger share of hospital financial resources allocated to administrative activities. Higher administrative expenses might reflect hospitals' operational effort in response to the pandemic or inefficient cost management.