Journal of general internal medicine
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Sexual violence (SV) and intimate partner violence (IPV) experiences are major social determinants of adverse health. There is limited prevalence data on these experiences for veterans, particularly across sociodemographic groups. ⋯ Understanding veterans' experiences of SV and IPV can inform identification and intervention efforts, especially for women and sexual minorities.
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Toxic work culture contributes to healthcare worker burnout and attrition, but little is known about how healthcare organizations can systematically create and promote a culture of civility and collegiality. ⋯ Analysis of positive feedback from a mortality review survey provided meaningful insights into a health system's culture of teamwork and values related to civility and collegiality when providing end-of-life care. Systematic collection and sharing of positive feedback is feasible and has the potential to promote positive culture change and improve healthcare worker well-being.
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Randomized Controlled Trial Multicenter Study
Implementation of Direct-to-Patient Mobile Teledermatology in VA.
Innovative technology can enhance patient access to healthcare but must be successfully implemented to be effective. ⋯ NCT03241589.
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A system's ability to function-its "systemness"-depends upon the mindsets and behaviors of its people, but what exactly is it that individuals do to constitute effective systems? Systemness requires three kinds of ongoing conversations devoted to (1) developing and maintaining a shared purpose or goal, (2) developing and maintaining a systems perspective-understanding how all the various parts fit together in service of the shared purpose and integrating many unique, diverse perspectives to gain a more complete understanding of the situation at hand-and (3) managing the myriad interdependencies of all the people involved in the work. These conversations are needed across all levels of scale, from one patient's care plan to the implementation of strategy for a whole organization. ⋯ The skills of personal reflection, self-differentiation, attunement, and multiple perspective-taking are particularly important. Understanding the conversations and individual skills on which systemness depends offers new directions for health professions education and quality improvement, and may be relevant to societal challenges beyond healthcare.
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COVID-19 led to an unprecedented reliance on virtual modalities to maintain care continuity for patients living with chronic pain. We examined whether there were disparities in virtual specialty pain care for racial-ethnic minority groups during COVID-19. ⋯ Disparities in virtual specialty pain care were smaller during the early phases of the COVID-19 pandemic than prior to the pandemic but did not disappear entirely, despite the rapid growth in telehealth. Targeted efforts to increase access to specialty pain care need to be concentrated among racial-ethnic minority groups.