Journal of general internal medicine
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Institutional Review Boards (IRBs) in the United States play a crucial role in ensuring the ethical conduct of clinical trials, including assessing the scientific merit of studies to justify the risks to participants. However, prior research suggests that many IRBs do not systematically evaluate scientific merit, raising concerns about the approval of low-quality trials. ⋯ IRB guidance materials vary in their coverage of scientific merit dimensions, with significant gaps in areas critical for assessing study quality. Strengthening guidance materials by including comprehensive instructions for all 15 dimensions could improve IRB assessments of scientific merit, thereby enhancing the ethical oversight of clinical trials.
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Alcohol-related hospitalizations are rising; however, medications for alcohol use disorder (M-AUD) are underprescribed despite their effectiveness to reduce heavy drinking. In-hospital administration of intramuscular (IM)-naltrexone may reduce negative health outcomes among people with AUD who are unable to take daily MAUD. ⋯ ACS clinicians viewed IM-naltrexone provision favorably. Some patients expressed concern about their alcohol use and its health impacts while others were ambivalent. Despite this, most accepted MAUD. All forms of MAUD should be offered in the hospital to support patients' recovery goals.
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Detailed grading of chills is more useful for diagnosing bacteremia than simply classifying the presence or absence of chills. However, its value added to other clinical information has not been evaluated. ⋯ Differentiating shaking chills in comparison with dichotomized chills for predicting bacteremia allowed the correct identification of an additional 4.6% of patients with bacteremia. Detailed grading of chills can be assessed without additional time, cost, or burden on patients and can be recommended in the routine history taking.