Subjects -> MEDICAL SCIENCES (Total: 8803 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (225 journals)
    - ANAESTHESIOLOGY (121 journals)
    - CARDIOVASCULAR DISEASES (350 journals)
    - CHIROPRACTIC, HOMEOPATHY, OSTEOPATHY (21 journals)
    - COMMUNICABLE DISEASES, EPIDEMIOLOGY (234 journals)
    - DENTISTRY (292 journals)
    - DERMATOLOGY AND VENEREOLOGY (167 journals)
    - EMERGENCY AND INTENSIVE CRITICAL CARE (127 journals)
    - ENDOCRINOLOGY (151 journals)
    - FORENSIC SCIENCES (44 journals)
    - GASTROENTEROLOGY AND HEPATOLOGY (191 journals)
    - GERONTOLOGY AND GERIATRICS (142 journals)
    - HEMATOLOGY (159 journals)
    - HYPNOSIS (4 journals)
    - INTERNAL MEDICINE (178 journals)
    - LABORATORY AND EXPERIMENTAL MEDICINE (98 journals)
    - MEDICAL GENETICS (58 journals)
    - MEDICAL SCIENCES (2446 journals)
    - NURSES AND NURSING (372 journals)
    - OBSTETRICS AND GYNECOLOGY (211 journals)
    - ONCOLOGY (395 journals)
    - OPHTHALMOLOGY AND OPTOMETRY (143 journals)
    - ORTHOPEDICS AND TRAUMATOLOGY (172 journals)
    - OTORHINOLARYNGOLOGY (84 journals)
    - PATHOLOGY (100 journals)
    - PEDIATRICS (277 journals)
    - PHYSICAL MEDICINE AND REHABILITATION (161 journals)
    - PSYCHIATRY AND NEUROLOGY (844 journals)
    - RADIOLOGY AND NUCLEAR MEDICINE (195 journals)
    - RESPIRATORY DISEASES (108 journals)
    - RHEUMATOLOGY (79 journals)
    - SPORTS MEDICINE (83 journals)
    - SURGERY (412 journals)
    - UROLOGY, NEPHROLOGY AND ANDROLOGY (159 journals)

INTERNAL MEDICINE (178 journals)                     

Showing 1 - 180 of 180 Journals sorted alphabetically
Abdomen     Open Access  
ACP Hospitalist     Full-text available via subscription   (Followers: 9)
ACP Internist     Full-text available via subscription   (Followers: 10)
ACP Journal Club     Full-text available via subscription   (Followers: 11)
Acta Clinica Belgica     Hybrid Journal   (Followers: 1)
Acute and Critical Care     Open Access   (Followers: 11)
Acute Medicine     Full-text available via subscription   (Followers: 9)
Advances in Hepatology     Open Access   (Followers: 4)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
African Journal of Primary Health Care & Family Medicine     Open Access   (Followers: 6)
African Journal of Thoracic and Critical Care Medicine     Open Access  
American Family Physician     Full-text available via subscription   (Followers: 38)
American Journal of Hypertension     Hybrid Journal   (Followers: 31)
Anales de Medicina Interna     Open Access   (Followers: 1)
Anatomy & Physiology : Current Research     Open Access   (Followers: 9)
Angiology     Hybrid Journal   (Followers: 5)
Annals of Colorectal Research     Open Access   (Followers: 1)
Annals of Internal Medicine     Full-text available via subscription   (Followers: 392)
AORN Journal     Hybrid Journal   (Followers: 27)
Apollo Medicine     Open Access  
Archives of Drug Information     Hybrid Journal   (Followers: 5)
Archivos de Medicina Interna     Open Access   (Followers: 1)
Asia Oceania Journal of Nuclear Medicine & Biology     Open Access   (Followers: 4)
Asian Pacific Journal of Tropical Disease     Full-text available via subscription   (Followers: 3)
Australasian Physical & Engineering Sciences in Medicine     Hybrid Journal   (Followers: 1)
BMI Journal : Bariátrica & Metabólica Iberoamericana     Open Access   (Followers: 1)
BMJ Open Diabetes Research & Care     Open Access   (Followers: 35)
BMJ Quality & Safety     Hybrid Journal   (Followers: 69)
Bone & Joint Journal     Hybrid Journal   (Followers: 139)
Brain Communications     Open Access   (Followers: 4)
Brain Science Advances     Open Access  
Canadian Journal of General Internal Medicine     Open Access   (Followers: 2)
Cardiovascular Medicine in General Practice     Full-text available via subscription   (Followers: 7)
Case Reports in Internal Medicine     Open Access   (Followers: 1)
Cell Death & Disease     Open Access   (Followers: 3)
Cellular and Molecular Gastroenterology and Hepatology     Open Access   (Followers: 3)
Cephalalgia     Hybrid Journal   (Followers: 8)
Cephalalgia Reports     Open Access   (Followers: 4)
Chronic Diseases and Injuries in Canada     Free   (Followers: 1)
Clinical Ethics     Hybrid Journal   (Followers: 13)
Clinical Liver Disease     Open Access   (Followers: 5)
Clinical Nutrition     Hybrid Journal   (Followers: 98)
Clinical Thyroidology     Full-text available via subscription   (Followers: 1)
CNE Pflegemanagement     Hybrid Journal  
Communication Law and Policy     Hybrid Journal   (Followers: 5)
Current Diabetes Reports     Hybrid Journal   (Followers: 30)
Current Hepatology Reports     Hybrid Journal  
Current Research: Integrative Medicine     Open Access  
CVIR Endovascular     Open Access   (Followers: 1)
Der Internist     Hybrid Journal   (Followers: 12)
Diabetes     Full-text available via subscription   (Followers: 603)
Diabetes Care     Full-text available via subscription   (Followers: 577)
Diabetes Internacional     Open Access  
Diabetes Spectrum     Full-text available via subscription   (Followers: 17)
Diagnosis     Hybrid Journal   (Followers: 1)
Egyptian Journal of Bronchology     Open Access  
Egyptian Journal of Internal Medicine     Open Access   (Followers: 1)
Egyptian Journal of Neurosurgery     Open Access  
Egyptian Liver Journal     Open Access   (Followers: 2)
Egyptian Spine Journal     Open Access  
EMC - Aparato Locomotor     Hybrid Journal  
Endovascular Neuroradiology / Ендоваскулярна нейрорентгенохірургія     Open Access   (Followers: 1)
eNeuro     Open Access   (Followers: 3)
Ergonomics     Hybrid Journal   (Followers: 24)
European Journal of Inflammation     Open Access   (Followers: 2)
European Journal of Internal Medicine     Full-text available via subscription   (Followers: 10)
European Journal of Translational Myology     Open Access  
European Radiology Experimental     Open Access   (Followers: 2)
Head and Neck Tumors     Open Access   (Followers: 1)
Health Sociology Review     Hybrid Journal   (Followers: 14)
HemaSphere     Open Access   (Followers: 2)
Hepatology Communications     Open Access  
Hepatoma Research     Open Access   (Followers: 3)
Human Physiology     Hybrid Journal   (Followers: 5)
ImmunoHorizons     Open Access  
Immunological Medicine     Open Access  
Infectious Diseases: Research and Treatment     Open Access   (Followers: 5)
Inflammation and Regeneration     Open Access   (Followers: 2)
Inflammatory Intestinal Diseases     Open Access  
Innere Medizin up2date     Hybrid Journal   (Followers: 1)
Internal and Emergency Medicine     Hybrid Journal   (Followers: 5)
Internal Medicine Journal     Hybrid Journal   (Followers: 9)
International Journal of Abdominal Wall and Hernia Surgery     Open Access   (Followers: 1)
International Journal of Anatomy and Research     Open Access   (Followers: 2)
International Journal of Angiology     Hybrid Journal  
International Journal of Artificial Organs     Hybrid Journal   (Followers: 3)
International Journal of Hyperthermia     Open Access  
International Journal of Internal Medicine     Open Access   (Followers: 3)
International Journal of Noncommunicable Diseases     Open Access  
International Journal of Psychiatry in Clinical Practice     Hybrid Journal   (Followers: 6)
Iranian Journal of Neurosurgery     Open Access   (Followers: 1)
Italian Journal of Anatomy and Embryology     Open Access   (Followers: 1)
JAC-Antimicrobial Resistance     Open Access   (Followers: 4)
JAMA Internal Medicine     Full-text available via subscription   (Followers: 363)
JCSM Clinical Reports     Open Access   (Followers: 3)
JHEP Reports     Open Access  
JIMD Reports     Open Access  
JMV - Journal de Médecine Vasculaire     Hybrid Journal   (Followers: 1)
Joint Commission Journal on Quality and Patient Safety     Hybrid Journal   (Followers: 41)
JOP. Journal of the Pancreas     Open Access   (Followers: 2)
Journal of Basic & Clinical Physiology & Pharmacology     Hybrid Journal   (Followers: 1)
Journal of Bone Oncology     Open Access   (Followers: 1)
Journal of Cancer & Allied Specialties     Open Access  
Journal of Clinical and Experimental Hepatology     Full-text available via subscription   (Followers: 3)
Journal of Clinical Movement Disorders     Open Access   (Followers: 3)
Journal of Community Hospital Internal Medicine Perspectives     Open Access  
Journal of Cutaneous Immunology and Allergy     Open Access  
Journal of Developmental Origins of Health and Disease     Hybrid Journal   (Followers: 2)
Journal of Endoluminal Endourology     Open Access  
Journal of Gastroenterology and Hepatology Research     Open Access   (Followers: 4)
Journal of General Internal Medicine     Hybrid Journal   (Followers: 23)
Journal of Hypertension     Hybrid Journal   (Followers: 14)
Journal of Infectious Diseases     Hybrid Journal   (Followers: 48)
Journal of Interdisciplinary Medicine     Open Access  
Journal of Internal Medicine     Hybrid Journal   (Followers: 11)
Journal of Liver : Disease & Transplantation     Hybrid Journal   (Followers: 7)
Journal of Medical Internet Research     Open Access   (Followers: 24)
Journal of Movement Disorders     Open Access   (Followers: 2)
Journal of Pain and Symptom Management     Hybrid Journal   (Followers: 46)
Journal of Pancreatic Cancer     Open Access  
Journal of Renal and Hepatic Disorders     Open Access  
Journal of Solid Tumors     Open Access   (Followers: 1)
Journal of Sports Medicine and Allied Health Sciences : Official Journal of the Ohio Athletic Trainers Association     Open Access   (Followers: 1)
Journal of the American Board of Family Medicine     Open Access   (Followers: 11)
Journal of the European Mosquito Control Association     Open Access  
Journal of Translational Internal Medicine     Open Access  
Jurnal Vektor Penyakit     Open Access  
La Revue de Medecine Interne     Full-text available via subscription   (Followers: 3)
Lege artis - Das Magazin zur ärztlichen Weiterbildung     Hybrid Journal   (Followers: 1)
Liver Cancer International     Open Access  
Liver Research     Open Access  
Molecular Diagnosis & Therapy     Hybrid Journal   (Followers: 3)
Molecular Therapy - Oncolytics     Open Access  
Multiple Sclerosis and Demyelinating Disorders     Open Access   (Followers: 7)
MYOPAIN. A journal of myofascial pain and fibromyalgia     Hybrid Journal   (Followers: 18)
Neuro-Oncology Advances     Open Access   (Followers: 1)
Neurobiology of Pain     Open Access   (Followers: 2)
Neurointervention     Open Access   (Followers: 6)
Neuromuscular Diseases     Open Access  
Nigerian Journal of Gastroenterology and Hepatology     Full-text available via subscription  
OA Alcohol     Open Access   (Followers: 5)
Oncological Coloproctology     Open Access  
Open Journal of Internal Medicine     Open Access  
Pleura and Peritoneum     Open Access  
Pneumo News     Full-text available via subscription  
Polish Archives of Internal Medicine     Full-text available via subscription   (Followers: 2)
Preventing Chronic Disease     Free   (Followers: 2)
Progress in Transplantation     Hybrid Journal   (Followers: 1)
Prostate International     Open Access   (Followers: 2)
Psychiatry and Clinical Psychopharmacology     Open Access   (Followers: 1)
Pulmonary Therapy     Open Access   (Followers: 2)
Quality of Life Research     Hybrid Journal   (Followers: 20)
Research and Practice in Thrombosis and Haemostasis     Open Access  
Revista Chilena de Fonoaudiología     Open Access   (Followers: 1)
Revista de la Sociedad Peruana de Medicina Interna     Open Access   (Followers: 4)
Revista del Instituto de Medicina Tropical     Open Access  
Revista Hispanoamericana de Hernia     Open Access   (Followers: 1)
Revista Médica Internacional sobre el Síndrome de Down     Full-text available via subscription   (Followers: 1)
Revista Virtual de la Sociedad Paraguaya de Medicina Interna     Open Access   (Followers: 1)
Romanian Journal of Diabetes Nutrition and Metabolic Diseases     Open Access   (Followers: 1)
Romanian Journal of Internal Medicine     Open Access  
Russian Journal of Child Neurology     Open Access   (Followers: 1)
Scandinavian Journal of Primary Health Care     Open Access   (Followers: 8)
Schlaf     Hybrid Journal  
Schmerzmedizin     Hybrid Journal  
Scientific Journal of the Foot & Ankle     Open Access   (Followers: 1)
SciMedicine Journal     Open Access   (Followers: 3)
SEMERGEN - Medicina de Familia     Full-text available via subscription   (Followers: 1)
The Journal of Critical Care Medicine     Open Access   (Followers: 9)
Therapeutic Advances in Chronic Disease     Open Access   (Followers: 8)
Therapeutic Advances in Musculoskeletal Disease     Hybrid Journal   (Followers: 6)
Thieme Case Report     Hybrid Journal   (Followers: 1)
Tijdschrift voor Urologie     Hybrid Journal  
Tissue Barriers     Hybrid Journal   (Followers: 1)
Transactions of the Royal Society of Tropical Medicine and Hygiene     Hybrid Journal   (Followers: 3)
Transgender Health     Open Access   (Followers: 3)
Trends in Anaesthesia and Critical Care     Full-text available via subscription   (Followers: 23)
US Cardiology Review     Open Access  
Vascular and Endovascular Review     Open Access   (Followers: 1)
Ожирение и метаболизм     Open Access  

           

Similar Journals
Journal Cover
BMJ Quality & Safety
Journal Prestige (SJR): 2.679
Citation Impact (citeScore): 4
Number of Followers: 69  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 2044-5415 - ISSN (Online) 2044-5423
Published by BMJ Publishing Group Homepage  [68 journals]
  • Harnessing choice architecture to improve medical care
    • Authors: Redelmeier, D. A; Kao, M.-M.
      Pages: 353 - 355
      Abstract: Introduction People live busy complex lives where most decisions need to be made quickly. As a consequence, people tend to prefer simple rather than expanded choice sets, easy alternatives that require no complex tradeoffs and benign options that avoid major moral quandaries. Choice architecture is defined formally as the behavioural science examining how the layout, sequencing and range of available options can influence decisions. The Google search engine, for example, is a familiar illustration of refined choice architecture where its spartan user interface tries to avoid overloading individuals, provoking deep thought or maximising information. The core assumption is that people want to feel gently guided and not overwhelmed. The intriguing insight is that many unrecognised features of choice architecture can influence decisions. In this issue of the journal, Hart et al explore physicians’ knowledge of choice architecture in medical care.1 The investigators focus on eight principles...
      PubDate: 2021-04-19T01:03:22-07:00
      DOI: 10.1136/bmjqs-2020-012598
      Issue No: Vol. 30, No. 5 (2021)
       
  • Advancing health equity in patient safety: a reckoning, challenge and
           opportunity
    • Authors: Chin M. H.
      Pages: 356 - 361
      Abstract: COVID-19 and police brutality have simultaneously heightened public awareness of disparities in health outcomes by race/ethnicity, gender, and socioeconomic status, and the underlying structural drivers of systemic racism and social privilege in the USA.1 2 Increasingly major professional associations such as the American Medical Association, American Hospital Association, and Association of American Medical Colleges are decrying racism and inequities, and many individual healthcare organisations are committing to addressing health disparities. Hospitals, clinics and health plans are looking inwards to identify organisational biases and discrimination, and developing outward interventions to advance health equity for their patients. Looking in the mirror honestly takes courage; frequently the discoveries and self-insights are troubling.3 At their best, discussions about racism and inequities are challenging.4 Within the quality of care field, disparities in patient safety are relatively understudied.5 6 Thus, Schulson et al’s...
      PubDate: 2021-04-19T01:03:22-07:00
      DOI: 10.1136/bmjqs-2020-012599
      Issue No: Vol. 30, No. 5 (2021)
       
  • Choice architecture in physician-patient communication: a mixed-methods
           assessments of physicians competency
    • Authors: Hart, J; Yadav, K, Szymanski, S, Summer, A, Tannenbaum, A, Zlatev, J, Daniels, D, Halpern, S. D.
      Pages: 362 - 371
      Abstract: BackgroundClinicians’ use of choice architecture, or how they present options, systematically influences the choices made by patients and their surrogate decision makers. However, clinicians may incompletely understand this influence.ObjectiveTo assess physicians’ abilities to predict how common choice frames influence people’s choices.MethodsWe conducted a prospective mixed-methods study using a scenario-based competency questionnaire and semistructured interviews. Participants were senior resident physicians from a large health system. Of 160 eligible participants, 93 (58.1%) completed the scenario-based questionnaire and 15 completed the semistructured interview. The primary outcome was choice architecture competency, defined as the number of correct answers on the eight-item scenario-based choice architecture competency questionnaire. We generated the scenarios based on existing decision science literature and validated them using an online sample of lay participants. We then assessed senior resident physicians’ choice architecture competency using the questionnaire. We interviewed a subset of participating physicians to explore how they approached the scenario-based questions and their views on choice architecture in clinical medicine and medical education.ResultsPhysicians’ mean correct score was 4.85 (95% CI 4.59 to 5.11) out of 8 scenario-based questions. Regression models identified no associations between choice architecture competency and measured physician characteristics. Physicians found choice architecture highly relevant to clinical practice. They viewed the intentional use of choice architecture as acceptable and ethical, but felt they lacked sufficient training in the principles to do so.ConclusionClinicians assume the role of choice architect whether they realise it or not. Our results suggest that the majority of physicians have inadequate choice architecture competency. The uninformed use of choice architecture by clinicians may influence patients and family members in ways clinicians may not anticipate nor intend.
      Keywords: Open access
      PubDate: 2021-04-19T01:03:22-07:00
      DOI: 10.1136/bmjqs-2020-011801
      Issue No: Vol. 30, No. 5 (2021)
       
  • Inpatient patient safety events in vulnerable populations: a retrospective
           cohort study
    • Authors: Schulson, L. B; Novack, V, Folcarelli, P. H, Stevens, J. P, Landon, B. E.
      Pages: 372 - 379
      Abstract: BackgroundWidespread attention to structural racism has heightened interest in disparities in the quality of care delivered to racial/ethnic minorities and other vulnerable populations. These groups may also be at increased risk of patient safety events.ObjectiveTo examine differences in inpatient patient safety events for vulnerable populations defined by race/ethnicity, insurance status and limited English proficiency (LEP).DesignRetrospective cohort study.SettingSingle tertiary care academic medical centre.ParticipantsInpatient admissions of those aged ≥18 years from 1 October 2014 to 31 December 2018.MeasurementsPrimary exposures of interest were self-identified race/ethnicity, Medicaid insurance/uninsured and LEP. The primary outcome of interest was the total number of patient safety events, defined as any event identified by a modified version of the Institute for Healthcare Improvement global trigger tool that automatically identifies patient safety events (‘automated’) from the electronic record or by the hospital-wide voluntary provider reporting system (‘voluntary’). Negative binomial models were used to adjust for demographic and clinical factors. We also stratified results by automated and voluntary.ResultsWe studied 141 877 hospitalisations, of which 13.6% had any patient safety event. In adjusted analyses, Asian race/ethnicity was associated with a lower event rate (incident rate ratio (IRR) 0.89, 95% CI 0.83 to 0.96); LEP patients had a lower risk of any patient safety event and voluntary events (IRR 0.91, 95% CI 0.87 to 0.96; IRR 0.89, 95% CI 0.85 to 0.94). Asian and Latino race/ethnicity were also associated with a lower rate of voluntary events but no difference in risk of automated events. Black race was associated with an increased risk of automated events (IRR 1.11, 95% CI 1.03 to 1.20).LimitationsThis is a single centre study.ConclusionsA commonly used method for monitoring patient safety problems, namely voluntary incident reporting, may underdetect safety events in vulnerable populations.
      Keywords: Editor's choice
      PubDate: 2021-04-19T01:03:23-07:00
      DOI: 10.1136/bmjqs-2020-011920
      Issue No: Vol. 30, No. 5 (2021)
       
  • Reporting incidents involving the use of advanced medical technologies by
           nurses in home care: a cross-sectional survey and an analysis of
           registration data
    • Authors: ten Haken, I; Ben Allouch, S, van Harten, W. H.
      Pages: 380 - 387
      Abstract: BackgroundAdvanced medical technologies (AMTs), such as respiratory support or suction devices, are increasingly used in home settings and incidents may well result in patient harm. Information about risks and incidents can contribute to improved patient safety, provided that those are reported and analysed systematically.ObjectivesTo identify the frequency of incidents when using AMTs in home settings, the effects on patient outcomes and the actions taken by nurses following identification of incidents.MethodsA cross-sectional study of 209 home care nurses in the Netherlands working with infusion therapy, parenteral nutrition or morphine pumps, combining data from a questionnaire and registration forms covering more than 13 000 patient contacts. Descriptive statistics were used.ResultsWe identified 140 incidents (57 adverse events; 83 near misses). The frequencies in relation to the number of patient contacts were 2.7% for infusion therapy, 1.3% for parenteral nutrition and 2.6% for morphine pumps. The main causes were identified as related to the product (43.6%), the organisation of care (27.9%), the nurse as a user (15.7%) and the environment (12.9%). 40% of all adverse events resulted in mild to severe harm to the patient. Incidents had been discussed in the team (70.7%), with the patient/informal caregiver(s) (50%), or other actions had been taken (40.5%). 15.5% of incidents had been formally reported according to the organisation’s protocol.ConclusionsMost incidents are attributed to product failures. Although such events predominantly cause no harm, a significant proportion of patients do suffer some degree of harm. There is considerable underreporting of incidents with AMTs in home care. This study has identified a discrepancy in quality circles: learning takes place at the team level rather than at the organisational level.
      Keywords: Open access
      PubDate: 2021-04-19T01:03:23-07:00
      DOI: 10.1136/bmjqs-2019-010510
      Issue No: Vol. 30, No. 5 (2021)
       
  • Variation in tonsillectomy cost and revisit rates: analysis of
           administrative and billing data from US childrens hospitals
    • Authors: Mahant, S; Richardson, T, Keren, R, Srivastava, R, Meier, J, for the Pediatric Research in Inpatient Setting (PRIS) Network
      Pages: 388 - 396
      Abstract: BackgroundTonsillectomy is one of the most common and cumulatively expensive surgical procedures in children. We determined if substantial variation in resource use, as measured by standardised costs, exists across hospitals for performing tonsillectomy and if higher resource use is associated with better quality of care, as measured by revisits to hospital.MethodsWe conducted a retrospective analysis of children undergoing routine outpatient tonsillectomy between 2011 to 2017 across US children's hospitals using an administrative and billing data source. The primary outcome measures were the hospital tonsillectomy standardised cost and the 30-day revisit rate to hospital. We analysed the interhospital variation in standardised cost by determining the number of outlier hospitals in standardised cost and the intraclass correlation coefficient.Results131 814 children (median age 6 years, IQR: 4,9; female sex 52.5%) underwent tonsillectomy for airway obstruction (62.9%) and infection (23.9%) across 28 hospitals. The median adjusted hospital standardised cost for tonsillectomy was $2392 (IQR: $1827, $2793; range: $1166 to $4222). There was substantial interhospital variation in costs as 11 (40%) hospitals were cost outliers, and the intraclass correlation coefficient was 0.62, suggesting that 62% of the variation in cost was attributable to variation between hospitals. The median hospital revisit rate was 9.5% (IQR: 7.8, 12.1) and higher hospital costs did not correlate with lower revisit rates (rs =0.03, 95% CI –0.36 to 0.41; p=0.87).ConclusionsThere is substantial variation in hospital resource use and standardised costs for routine outpatient tonsillectomy across US children’s hospitals. Higher resource use is not associated with lower revisit rates. Further study is needed to understand the practices of lower resource use hospitals who deliver high quality of care.
      PubDate: 2021-04-19T01:03:23-07:00
      DOI: 10.1136/bmjqs-2019-010730
      Issue No: Vol. 30, No. 5 (2021)
       
  • Distance travelled to hospital for emergency laparotomy and the effect of
           travel time on mortality: cohort study
    • Authors: Salih, T; Martin, P, Poulton, T, Oliver, C. M, Bassett, M. G, Moonesinghe, S. R, NELA Project Team, Anderson, Bassett, Cripps, Cripps, Cromwell, Davies, Drake, Eugene, Goodwin, Grocott, Hare, Johnston, Kuryba, Lockwood, Lourtie, Ramani Moonesinghe, Murray, Oliver, Papadimitriou, Peden, Poulton, Salih, Walker, Warren
      Pages: 397 - 406
      Abstract: ObjectivesTo evaluate whether distance and estimated travel time to hospital for patients undergoing emergency laparotomy is associated with postoperative mortality.DesignNational cohort study using data from the National Emergency Laparotomy Audit.Setting171 National Health Service hospitals in England and Wales.Participants22 772 adult patients undergoing emergency surgery on the gastrointestinal tract between 2013 and 2016.Main outcome measuresMortality from any cause and in any place at 30 and 90 days after surgery.ResultsMedian on-road distance between home and hospital was 8.4 km (IQR 4.7–16.7 km) with a median estimated travel time of 16 min. Median time from hospital admission to operating theatre was 12.7 hours. Older patients live on average further from hospital and patients from areas of increased socioeconomic deprivation live on average less far away.We included estimated travel time as a continuous variable in multilevel logistic regression models adjusting for important confounders and found no evidence for an association with 30-day mortality (OR per 10 min of travel time=1.02, 95% CI 0.97 to 1.06, p=0.512) or 90-day mortality (OR 1.02, 95 % CI 0.97 to 1.06, p=0.472).The results were similar when we limited our analysis to the subgroup of 5386 patients undergoing the most urgent surgery. 30-day mortality: OR=1.02 (95% CI 0.95 to 1.10, p=0.574) and 90-day mortality: OR=1.01 (95% CI 0.94 to 1.08, p=0.858).ConclusionsIn the UK NHS, estimated travel time between home and hospital was not a primary determinant of short-term mortality following emergency gastrointestinal surgery.
      Keywords: Open access
      PubDate: 2021-04-19T01:03:23-07:00
      DOI: 10.1136/bmjqs-2019-010747
      Issue No: Vol. 30, No. 5 (2021)
       
  • Promise and perils of patient decision aids for reducing low-value care
    • Authors: Thompson, R; Muscat, D. M, Jansen, J, Cox, D, Zadro, J. R, Traeger, A. C, McCaffery, K.
      Pages: 407 - 411
      Abstract: Recognition of excessive waste and harm in health systems has prompted efforts to reduce low-value care, which has been defined as ‘use of an intervention where evidence suggests it confers no or very little benefit on patients, or risk of harm exceeds likely benefit, or, more broadly, the added costs of the intervention do not provide proportional added benefits’.1 The development and distribution of patient decision aids (and the related practice of shared decision-making) has been advocated as a promising strategy for reducing low-value care. However, this idea has not been scrutinised in the scientific literature nor hypothesised mechanisms of effect fully elucidated. To address this, we offer an analysis of observed and possible effects of patient decision aids that aim to reduce low-value care, conclude that there is not yet compelling evidence that patient decision aids will reduce low-value care and make recommendations that may mitigate...
      PubDate: 2021-04-19T01:03:23-07:00
      DOI: 10.1136/bmjqs-2020-012312
      Issue No: Vol. 30, No. 5 (2021)
       
  • Its time to consider national culture when designing team training
           initiatives in healthcare
    • Authors: Rice, J; Daouk-Öyry, L, Hitti, E.
      Pages: 412 - 417
      Abstract: Introduction The cultivation of a workplace culture that promotes patient safety is critical to the delivery of healthcare around the world. Since the 1999 Institution of Medicine report To Err is Human there has been growing focus on healthcare safety.1 Breakdowns in communication and teamwork are often cited as root causes of preventable medical error in hospital and malpractice claims data.2 Patient safety initiatives that focus on individual and team behaviours have been shown to improve the quality and safety of healthcare.1 2 Taking cues from the aviation industry, hospital safety team training programmes aim to flatten hierarchy, promote communication clarity and emphasise a team-oriented approach to patient care.3 Given that individual behaviours and interpersonal dynamics are highly impacted by cultural context, it is no surprise growing evidence suggests important regional differences in healthcare safety culture.4–6
      PubDate: 2021-04-19T01:03:23-07:00
      DOI: 10.1136/bmjqs-2020-010918
      Issue No: Vol. 30, No. 5 (2021)
       
  • A realist synthesis of pharmacist-conducted medication reviews in primary
           care after leaving hospital: what works for whom and why'
    • Authors: Luetsch, K; Rowett, D, Twigg, M. J.
      Pages: 418 - 430
      Abstract: BackgroundMedication reviews for people transitioning from one healthcare setting to another potentially improve health outcomes, although evidence for outcome benefits varies. It is unclear when and why medication reviews performed by pharmacists in primary care for people who return from hospital to the community lead to beneficial outcomes.ObjectiveA realist synthesis was undertaken to develop a theory of what works, for whom, why and under which circumstances when pharmacists conduct medication reviews in primary care for people leaving hospital.MethodsThe realist synthesis was performed in accordance with Realist And MEta-narrative Evidence Syntheses: Evolving Standards reporting standards. An initial programme theory informed a systematic literature search of databases (PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature, International Pharmaceutical s, OpenGrey, Trove), augmented by agency and government sources of information. Documents were synthesised by exploring interactions between contexts, intervention, outcomes and causal mechanisms.ResultsThe synthesis identified 9 contexts in which 10 mechanisms can be activated to influence outcomes of pharmacist medication reviews conducted in primary care postdischarge. For a medication review to take place these include trust patients have in healthcare professionals, their healthcare priorities postdischarge, capacity to participate, perceptions of benefit and effort, and awareness required by all involved. For the medication review process, mechanisms which issue an invitation to collaborate between healthcare professionals, enable pharmacists employing clinical skills and taking responsibility for medication review outcomes were linked to more positive outcomes for patients.ConclusionsMedication reviews after hospital discharge seem to work successfully when conducted according to patient preferences, programmes promote coordination and collaboration between healthcare professionals and establish trust, and pharmacists take responsibility for outcomes. Findings of this realist synthesis can inform postdischarge medication review service models.
      Keywords: Open access
      PubDate: 2021-04-19T01:03:23-07:00
      DOI: 10.1136/bmjqs-2020-011418
      Issue No: Vol. 30, No. 5 (2021)
       
  • Nurses and nursing support matter: interpreting the evidence
    • Authors: Needleman, J; Stone, P. W.
      Pages: 431 - 431
      Abstract: To the editors, In their editorial commenting on our paper ‘Association of registered nurse and nursing support staffing with inpatient hospital mortality’,1 Aiken and Sloane present our study results, conclusions and implications as if we examined the impact of substituting nursing support staff for professional nurses or registered nurses (RNs). We did not examine substitution of support staff for RNs (commonly called skill mix) in this study and, as Aiken and Sloane acknowledge, we stated our findings should not be interpreted to mean that nursing aides can safely substitute for RNs. Nonetheless, Aiken and Sloane discuss our current paper as though it is about skill mix, characterising our findings as ‘counter’ to earlier published papers by us in which we did in fact analyse skill mix. In those studies,e.g.,2 3 we show efforts to deskill the nursing work force will increase deaths, adverse...
      PubDate: 2021-04-19T01:03:23-07:00
      DOI: 10.1136/bmjqs-2020-010830
      Issue No: Vol. 30, No. 5 (2021)
       
  • Quality & safety in the literature: May 2021
    • Authors: Gonzalez, J. J; Houchens, N, Gupta, A.
      Pages: 432 - 436
      Abstract: Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies recently published in major medical journals. Some articles will focus on a particular theme, whereas others will highlight unique publications from high-impact medical journals. Key points
      Clinicians in the United States (US) spend more time actively using electronic health records (EHRs), receive more system-generated messages, write a higher proportion of automatically generated note text and spend more time using the EHR after working hours, compared with non-US clinicians. JAMA Int Med, 14 December 2020
      US clinicians prescribe a significantly larger quantity of opioid medications on postoperative discharge and display a greater variation in opioid prescribing patterns compared with the rest of the world. Annals of...
      PubDate: 2021-04-19T01:03:23-07:00
      DOI: 10.1136/bmjqs-2021-013322
      Issue No: Vol. 30, No. 5 (2021)
       
 
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