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A Pictorial Essay of Immunotherapy: Complications that Internists Will See, Whether They Like it or Not

Delirium is highly prevalent in hospitalized patients and is a strong and consistent negative predictor of length of stay, mortality, and long-term cognitive outcomes.1 Symptoms commonly associated with delirium include reduced ability to focus, sleep disturbances, psychomotor agitation, and emotional disturbances. The management of the behavioral disturbances of delirium is challenging. Although non-pharmacologic means to reduce […]

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Health professional wellness hierarchy.

Beyond Burnout: A Physician Wellness Hierarchy Designed to Prioritize Interventions at the Systems Level

Burnout has been implicated in higher physician turnover, reduced patient satisfaction, and worsened safety, but understanding the degree of burnout in a given physician or team does not direct leaders to solutions. The model proposed integrates a long list of variables that may ameliorate burnout into a prioritized, easy-to-understand hierarchy. Modified from Maslow’s hierarchy, the […]

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Young Adults and Adverse Childhood Events: A Potent Measure of Cardiovascular Risk

  While cardiovascular disease is the leading cause of death, its determinants include unhealthy behaviors and clinical risk factors and are recognized as the “actual causes” of death. Risk likely accumulates over the life course, and adverse childhood experiences may increase the risk of “actual causes” of death. The objectives of the study are to […]

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doctor shaking hands with female patient

Building Trust in the Profession: What Can We Learn from Choosing Wisely?

  The Choosing Wisely campaign sought to prompt physician–patient conversations about unnecessary care. At its 2012 launch, physicians and patients felt uncomfortable about “denying” even unnecessary or potentially harmful care. Opponents of the Affordable Care Act raised fears of rationing and death panels. Physicians and patients had long mistrusted the motives of third parties, including […]

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nurse speaking to a patient in bed

The Rise of Documentation and the Destruction of Modern Medicine

The doctor–patient relationship has remained a central theme in the art of medicine since Hippocrates. Investing time into this relationship ensures trust and communication between both parties during a patient’s most vulnerable moments. Unfortunately, however, it seems as if the doctor–patient interaction has been gradually declining over time. The widespread implementation and dissemination of the […]

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Team-Based Primary Care for the Multimorbid Patient: Matching Complexity With Complexity

Complex, multimorbid patients are individuals within whom multiple chronic diagnoses (usually, more than two)1intersect additional complications—diminished function, cognitive impairment, homelessness, or substance abuse, for example. As many as one third of patients are multimorbid, with correlates of socioeconomic deprivation, increasing health services utilization, and mental health comorbidity.2 The growing scope and scale of care for complex, […]

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