Hospital readmissions reduction program penalizes safety net hospital clinicians.

Objective: The Hospital Readmissions Reduction Program (HRRP), started under the Patient Protection and Affordable Care Act and administered by the Centers for Medicare and Medicaid Services, was created with the intention to improve healthcare quality and costs. However, research on disparities in healthcare demonstrates the HRRP's protocolized risk-adjustment calculations neglect social factors, which consequently harms disadvantaged patient populations and unfairly contributes to clinician and hospital penalties.

Methods: A PRISMA literature review was conducted using PubMed and Cochrane Library to explore the inclusion of social factors such as socioeconomic status on risk-adjustment calculations, and their relation to healthcare disparities, penalties, and outcomes.

Time to Publication in Medical Education Journals: An Analysis of Publication Timelines During COVID-19 (2019-2022).

Introduction: COVID-19 changed scholarly publishing. Yet, its impact on medical education publishing is unstudied. Because journal articles and their corresponding publication timelines can influence academic success, the field needs updated publication timelines to set evidence-based expectations for academic productivity.

The Next Era of Assessment Within Medical Education: Exploring Intersections of Context and Implementation.

In competency-based medical education (CBME), which is being embraced globally, the patient-learner-educator encounter occurs in a highly complex context which contributes to a wide range of assessment outcomes. Current and historical barriers to considering context in assessment include the existing post-positivist epistemological stance that values objectivity and validity evidence over the variability introduced by context. This is most evident in standardized testing.

Mechanisms of Injury Leading to Concussions in Collegiate Soccer Players: A CARE Consortium Study.

Background: Few previous studies have investigated how different injury mechanisms leading to sport-related concussion (SRC) in soccer may affect outcomes.

Purpose: To describe injury mechanisms and evaluate injury mechanisms as predictors of symptom severity, return to play (RTP) initiation, and unrestricted RTP (URTP) in a cohort of collegiate soccer players.

Study Design: Cohort study; Level of evidence, 2.

Centering Justice in Health Professions Education by Owning Limitations of Anti-Bias Checklists.

This article argues that, although efforts to integrate checklists for assessing bias in educational content represent a sincere effort to address or mitigate harm, such efforts will likely have limited (if any) impact on curricular reform or the actual lived experiences of minoritized students. This is because checklists are not designed for justice-oriented assessment and thus will not create the kind of change needed to transform health professions, especially medical education. What is needed is more attention to the ways whiteness is used to organize health professions education and a deep commitment to faculty development focused on raising educators' critical consciousness.

What Should Students and Trainees Be Taught About and Where Patients Belong?

Turfing is a colloquialism that refers to what clinicians do to patients whose needs do not fit neatly and tidily into typical clinical placement protocols, especially during inpatient admissions from a hospital's emergency department. This term and this practice are both clinically and ethically problematic because a patient is rarely, if ever, "turfed" to their advantage. Ethically speaking, turfing constitutes deferral of responsibility for a patient's admission or care to colleagues.

Assessment of Veterans Affairs Case Management Leadership.

Purpose/objectives: The critical work of Veterans Affairs (VA) case managers is to assist and advocate for veterans navigating the VA and civilian health care systems, aligning services, developing integrated care plans, and supporting team-based care (Hunt & Burgo-Black, 2011). The article reviews publications regarding VA case management leadership because case managers who function as leaders are likely to better coordinate health care services for veterans.

Primary Practice Setting: VA case managers adhere to the Commission for Case Managers (CCM) scope of practice through patient advocacy, education, and resource management, while ensuring the care is safe, effective, and equitable.

Tool to improve patient-provider interactions in adult primary care: Randomized controlled pilot study.

Objective: To assess whether an intervention to help patients prioritize goals for their visit would improve patient-provider communication and clinical outcomes.

Design: Randomized controlled pilot study.

Setting: Primary care clinic.

Three Primary Cancers in a Veteran With Agent Orange and Agent Blue Exposures.

A Vietnam War veteran's exposures likely contributed to his cancer diagnoses, but these associations are confounded by his substance use, particularly cigarette smoking.

Albuterol, Acidosis, and Aneurysms.

A patient with a complicated medical history on admission for dyspnea was administered nebulizer therapy but after 72 hours developed asymptomatic acute kidney injury and anion-gap metabolic acidosis.

Gastrointestinal Symptoms and Lactic Acidosis in a Chronic Marijuana User.

A patient presented with diffuse abdominal pain and a history of frequent cannabis use, a diet lacking in meat and fish, and an increase in consumption of simple carbohydrates in the past year.

"To Conserve Fighting Strength": The Role of Military Culture in the Delivery of Care.

Introduction: There are ongoing discussions about reorganizing the delivery of health care within the US Armed Forces. The military cultural context of care has beneficial qualities for patients with orthopedic and extremity trauma acquired during deployments to conflict zones.

Methods: The study included 35 participants with lower limb amputations who had been discharged from the Amputee Patient Care Program ≥ 12 months prior to the study.

Lipoprotein(a) Elevation: A New Diagnostic Code with Relevance to Service Members and Veterans.

Newly recognized as a clinical diagnosis, Lp(a) elevation is a major contributor to cardiovascular disease risk should be considered for patients with advanced premature atherosclerosis on imaging or a family history of premature cardiovascular disease, particularly when there are few traditional risk factors.

Effects of Process Improvement on Guideline-Concordant Cardiac Enzyme Testing.

Easily implemented ordering practices in the electronic health record increased the rate of guideline-concordant testing, decreased cost, and furthered the goal of high-value medical care.

Nonalcoholic Steatohepatitis and Endpoints in Clinical Trials.

Nonalcoholic fatty liver disease (NAFLD) is now the leading cause of liver disease in developed countries, and the rates of NAFLD continue to rise in conjunction with the obesity pandemic. While the majority of patients with isolated steatosis generally have a benign course, a diagnosis of nonalcoholic steatohepatitis (NASH) carries a significantly higher risk for progression of disease, cirrhosis, and death. Pharmacologic therapeutic interventions in NASH have largely proven to be ineffective or unappealing due to long-term side-effect profiles, and the majority of patients cannot achieve or sustain targeted weight loss goals, necessitating an urgent need for therapeutic trials and drug development.

FDA Black Box, VA Red Ink? A Successful Service-Connected Disability Claim for Chronic Neuropsychiatric Adverse Effects From Mefloquine.

More veterans are likely to present to the VA with service-connected claims for adverse effects related to exposure to a prophylactic antimalarial drug commonly used by the military for more than 2 decades.

The VA/DoD Chronic Effects of Neurotrauma Consortium: An Overview at Year 1.

This federally funded program identifies gaps in research and provides support services for scientific, clinical, and translational research projects focused on the long-term effects of mild traumatic brain injury in veterans and active-duty service members.

Correlation between subjective and objective results in nasal surgery.

Background: There is a lack of medical literature demonstrating a positive correlation between subjective and objective results in functional nasal surgery.

Objective: The author presents his experience measuring nasal function subjectively and objectively before and after functional nasal surgery.

Methods: Between March 2011 and June 2012, a total of 119 consecutive patients with nasal obstruction underwent rhinoplasty with a variety of septorhinoplasty techniques.

When a mother wants to deliver with a midwife at home.

In this special issue of The Journal of Clinical Ethics, different views on both the ethical desirability of women delivering in hospitals or at home with midwives are discussed. What careproviders, including midwives, should recommend to mothers in regard to the place of giving birth is considered. Emotional concerns likely to be of importance to mothers, fathers, midwives, and doctors are also presented.

Families, strangers, and those most alone: insights from cultures, including our own.

In this introduction to this issue of The Journal of Clinical Ethics (JCE), I will discuss the legacy of our recently departed friend and colleague, Edmund D. Pellegrino, MD. In this light, I will discuss three articles in this issue of the journal that provide insight into the cultures of China, Mexico, and the U.