Journal of general internal medicine
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Randomized Controlled Trial Multicenter Study
Effect of patient- and medication-related factors on inpatient medication reconciliation errors.
Little research has examined the incidence, clinical relevance, and predictors of medication reconciliation errors at hospital admission and discharge. ⋯ Medication reconciliation errors are common at hospital admission and discharge. Errors in preadmission medication histories are associated with older age and number of medications and lead to more discharge reconciliation errors. A recent medication list in the EMR is protective against medication reconciliation errors.
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Although early recognition and treatment of diabetes may be essential to prevent complications, roughly one-fifth of diabetes remains undiagnosed. ⋯ In a nationally representative sample of individuals with undiagnosed diabetes, cardio-metabolic risk factor levels were high across all racial/ethnic groups, but NHB and MA had poorer control compared to NHW. Interventions that target identification of diabetes and treatment of cardio-metabolic risk factors are needed.
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Multicenter Study
Financial responsibility of hospitalized patients who left against medical advice: medical urban legend?
Physicians may counsel patients who leave against medical advice (AMA) that insurance will not pay for their care. However, it is unclear whether insurers deny payment for hospitalization in these cases. ⋯ Contrary to popular belief, we found no evidence that insurance denied payment for patients leaving AMA. Residency programs and hospitals should ensure that patients are not misinformed.
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Histamine fish poisoning, also known as scombroid poisoning, is a histamine toxicity syndrome that results from eating specific types of spoiled fish. Although typically a benign syndrome, characterized by self-limited flushing, headache, and gastrointestinal symptoms, we describe a case unique in its severity and as a precipitant of an asthma exacerbation. ⋯ A diagnosis of histamine fish poisoning was made and the patient was treated supportively and discharged within 24 hours, but was readmitted within 3 hours due to an asthma exacerbation. Her course was complicated by recurrent admissions for asthma exacerbations.
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Multicenter Study
Preventing hospital-acquired infections: a national survey of practices reported by U.S. hospitals in 2005 and 2009.
Hospital-acquired infection (HAI) is common, costly, and potentially lethal. Whether initiatives to reduce HAI--such as the Centers for Medicare and Medicaid Services (CMS) no payment rule--have increased the use of preventive practices is not known. ⋯ Since 2005, use of key practices to prevent CLABSI, VAP and CAUTI has increased in non-federal and VA hospitals, suggesting that despite its perceived importance, the non-payment rule may not be the primary driver. Moreover, while 65% of non-federal hospitals reported a moderate or large increase in preventing CAUTI as a facility priority, prevention practice use remains low.