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How Well Are Pulses Measured?

Although taking a radial pulse is considered to be an essential clinical skill, there have been few reports on how well it is measured in clinical practice, and how its accuracy and precision are influenced by rate, rhythm, and blood pressure. Methods This study is a retrospective quality audit carried out as part of a […]

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The Intention-to-Treat Analysis Is Not Always the Conservative Approach

The randomized trial design can be thought of as a means to answer 2 types of general questions: 1) what is the effect of assigning a treatment?; or 2) what is the effect of receiving a treatment? In public health, we are normally concerned with the first question—the effect of assigning a treatment. If we […]

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Mindfulness-Based Laboratory Reduction: Reducing Utilization Through Trainee-Led Daily ‘Time Outs’

Overuse of laboratory investigations is widely prevalent in hospitalized patients, leads to discomfort, and increases direct and indirect costs. Objective We implemented a simple, inexpensive, mindfulness strategy on our inpatient medical clinical teaching unit to reduce unnecessary laboratory orders through education, a forcing function, and daily structured laboratory “time outs.” Methods On a 26-bed unit […]

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Advancing High-Value Health Care: A New AJM Column Dedicated to Cost-Conscious Care Quality Improvement

Despite the very high cost of health care in the US, expenditure continues to rise. According to the Centers for Medicare & Medicaid Services, health care expenditures for 2016 are projected to be $3.4 trillion, and the percentage of the gross domestic product spent on health care will increase from 17.4% in 2013 to 19.6% […]

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doctor talking on cell phone stting at his desk, looking at computer

The New Trend in Medicine

During the 4 decades of my clinical training and practice of medicine, I always felt a sense of ownership and full responsibility in caring for my patients. What I have noticed over the past decade is a gradual transformation in our health care delivery system and in the attitude of our trainees. Hospitals are being governed […]

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