A systematic review and meta-analysis of English language online patient education materials in breast cancer: Is readability the only story?

Background: Online patient education materials (OPEMs) are an increasingly popular resource for women seeking information about breast cancer. The AMA recommends written patient material to be at or below a 6th grade level to meet the general public's health literacy. Metrics such as quality, understandability, and actionability also heavily influence the usability of health information, and thus should be evaluated alongside readability.

Clinician Ordering and Management Patterns of Urine Toxicology Results at a Cancer Center.

Context: Opioid therapy is a cornerstone for treatment of cancer-related pain, but standardized management practices for patients with cancer and aberrant urine drug test (UDT) results are lacking.

Objectives: To identify the prevalence of UDT ordering (both screening and definitive testing) in the oncology setting and to examine clinician management practices for patients with cancer on opioid therapy with aberrant definitive UDT results.

Methods: We conducted a retrospective chart review of patients with cancer on opioid therapy at an academic cancer center in the United States.

Completion Rates and Timeliness of Diagnostic Colonoscopies for Rectal Bleeding in Primary Care.

Background: Rectal bleeding is the most common presenting symptom of colorectal cancer, and guidelines recommend timely follow-up, usually with colonoscopy to ensure timely diagnoses of colorectal cancer.

Objective: Identify loop closure rates and vulnerable process points for patients with rectal bleeding.

Design: Retrospective cohort study, using medical record review of patients aged ≥ 40 with index diagnosis of rectal bleeding at 2 primary practices-an urban academic practice and affiliated community health center, between January 1, 2018, and December 31, 2020.

Burnout Among Hospitalists During the Early COVID-19 Pandemic: a National Mixed Methods Survey Study.

Unlabelled: BACKGROUND  : Hospitalist physician stress was exacerbated by the pandemic, yet there have been no large scale studies of contributing factors.

Objective: Assess remediable components of burnout in hospitalists.

Participants, Study Design And Measures: In this Coping with COVID study, we focused on assessment of stress factors among 1022 hospital-based clinicians surveyed between April to December 2020.

Developing a Framework and Electronic Tool for Communicating Diagnostic Uncertainty in Primary Care: A Qualitative Study.

Importance: Communication of information has emerged as a critical component of diagnostic quality. Communication of diagnostic uncertainty represents a key but inadequately examined element of diagnosis.

Objective: To identify key elements facilitating understanding and managing diagnostic uncertainty, examine optimal ways to convey uncertainty to patients, and develop and test a novel tool to communicate diagnostic uncertainty in actual clinical encounters.

Closing the Loop: Re-engineering the Assessment and Tracking of Symptoms in Primary Care.

Reliable systems that track the continuation, progression, or resolution of a patient's symptoms over time are essential for reliable diagnosis and ensuring that patients harboring more worrisome diagnoses are safely followed up. Given their first-contact role and increasing stresses on busy primary care clinicians and practices, new processes that make these tasks easier rather than creating more work for busy clinicians are especially needed.Some symptoms are sufficiently worrisome that they demand an urgent diagnosis and treatment while others result in a differential that can be more safely explored over time, or less differentiated and worrisome that they are best managed with the "test of time" to see if they resolve, worsen, or evolve into symptoms that are more worrisome.

Urgent referrals from primary care to dermatology for lesions suspicious for skin cancer: patterns, outcomes, and need for systems improvement.

Ideally, urgent dermatology referrals for evaluation of a lesion concerning for skin cancer should be triaged and processed with appropriate urgency by primary care and dermatology, respectively. We performed a retrospective single-institution study by conducting chart reviews of all dermatology referrals designated by primary care as urgent for evaluation of a lesion concerning for skin cancer. We identified 320 referrals placed between January 1 and December 31, 2018.

The impact of clinical uncertainty in the graduate medical education (GME) learning environment: A mixed-methods study.

Background: Uncertainty is ubiquitous in medicine. Studies link intolerance of uncertainty to burnout, ineffective communication, cognitive bias, and inappropriate resource use. Little is known about how uncertainty manifests in the clinical learning environment.

Is Oral Health Essential?

Since 1840, when the first dental school in the United States was founded, educational and policy outcomes have reinforced the separation of dentistry from medicine. Originating in serial historical divides, this separation has produced grave health inequity. The COVID-19 pandemic illuminates differences in medical and dental care delivery streams and also suggests how to design a unified health care system that transcends historical precedent.

Which factors are associated with the number of dental providers employed in correctional settings?

Objectives: Individuals experiencing incarceration are at increased risk of poor oral health. The purpose of this study was to identify state-level factors that influence the number of oral healthcare providers employed in US correctional settings.

Methods: This ecological study utilized the National Survey of Prison Health Care (NSPHC) to identify the total number of dentists employed in US correctional facilities.

Indication alerts to improve problem list documentation.

Background: Problem lists represent an integral component of high-quality care. However, they are often inaccurate and incomplete. We studied the effects of alerts integrated into the inpatient and outpatient computerized provider order entry systems to assist in adding problems to the problem list when ordering medications that lacked a corresponding indication.

Moving the needle on primary care burnout: Using a driver diagram to accelerate impact.

Prior to the COVID-19 pandemic, studies demonstrated an alarming prevalence of burnout in primary care. In the midst of the pandemic, primary care clinician wellbeing deteriorated and burnout rates increased, yet many organizational efforts to reduce burnout were put on hold due to the urgency of the pandemic. In this article, we present the "Reducing Burnout Driver Diagram" as a tool that clinical leaders and policy makers can use to address and mitigate primary care clinician burnout.

Entrustable Professional Activities in Oral Health for Primary Care Providers Based on a Scoping Review.

Despite advances in oral health care, inequalities in oral health outcomes persist due to problems in access. With proper training, primary care providers can mitigate this inequality by providing oral health education, screening, and referral to advanced dental treatment. Diverging sets of oral health competencies and guidelines have been released or endorsed by multiple primary care disciplines.

The Impact of Oral Health Training for Primary Care Clinicians: A Systematic Review.

Background And Objectives: Despite recent improvements in access to health care, many Americans still lack access to dental care. There has been a national focus on interprofessional education and team-based care to work toward the integration of services including dental care into primary care. The purpose of this systematic review is to understand the impact of implementing oral health curricula in primary care training on measurable changes in primary care practice.

A Prescription For Enhancing Electronic Prescribing Safety.

While electronic prescribing has been shown to reduce medication errors and improve prescribing safety, it is vulnerable to error-prone processes. We review six intersecting areas in which changes to electronic prescribing systems, particularly in the outpatient setting, could transform medication ordering quality and safety. We recommend incorporating medication indications into electronic prescribing, establishing a single shared online medication list, implementing the transmission of electronic cancellation orders to pharmacies (CancelRx) to ensure that drugs are safely and reliably discontinued, implementing standardized structured and codified prescription instructions, reengineering clinical decision support, and redesigning electronic prescribing to facilitate the ordering of nondrug alternatives.

A Comprehensive Theory of Integration.

Efforts to transform health care delivery to improve care have increasingly focused on care integration. However, variation in how integration is defined has complicated efforts to design, synthesize, and compare studies of integration in health care. Evaluations of integration initiatives would be enhanced by describing them according to clear definitions of integration and specifying which empirical relationships they seek to test-whether among types of integration or between integration and outcomes of care.

Medicine and Mass Incarceration: Education and Advocacy in the New York City Jail System.

The United States incarcerates more people than any other country in the world. The scale of mass incarceration ensures that almost all practicing physicians will treat formerly incarcerated patients. Yet the majority of physicians receive little training on this topic.

Compassionate Release Policy Reform: Physicians as Advocates for Human Dignity.

A rapidly aging correctional population has led to an increasing number of patients with serious progressive and terminal illnesses in correctional settings. "Compassionate release" describes a range of policies offering early release or parole to incarcerated patients with serious or debilitating illnesses. However, in many states that have compassionate release policies, few patients are actually granted release.

The Impact of Alternative Payment in Chronically Ill and Older Patients in the Patient-centered Medical Home.

Background: Patient-centered medical home (PCMH) has gained prominence as a promising model to encourage improved primary care delivery. There is a paucity of studies that evaluate the impact of payment models in the PCMH.

Objectives: We sought to examine whether coupling coordinated, team-based care transformation plan with a novel reimbursement model affects outcomes related to expenditures and utilization.

Sick Children Crying for Help: Fostering Adverse Event Reports.

In a Perspective, Gordon Schiff discusses the importance of appropriately analyzing adverse event reports.