Medication reconciliation (MedRec) is a cornerstone patient safety practice during care transitions. However, evidence regarding the specific implementation strategies that contribute to its effectiveness remains limited. This study sought to elucidate the essential ingredients of a Medication Reconciliation Standard Operating Protocol (MedRec SOP) and their impact on enhancing patient safety outcomes compared to usual care. We conducted a mixed-methods systematic review following PRISMA guidelines. PubMed, Web of Science, and Embase were searched for studies (January 2000–May 2024) assessing MedRec interventions compared to usual care. Data on study design, MedRec SOP components, and patient safety outcomes were extracted. Random-effects meta-analyses were performed for quantitative synthesis. From 7209 screened records, 70 studies were included, describing 20 distinct MedRec SOP ingredients. Meta-analysis demonstrated that MedRec significantly reduced medication discrepancies (RR = 0.39, 95
Ambient AI scribes are being deployed across health systems to reduce documentation burden and clinician burnout, with encouraging early results. However, because these tools generate clinical notes from speech, they capture what is said during the encounter, not what clinicians observe without verbalizing or judge without articulating. This Perspective argues that this omission is not just a workflow limitation but an epistemological one. Drawing on the dual-process model of clinical reasoning, research on clinician intuition, and the verbal overshadowing literature from cognitive psychology, it suggests that audio-based documentation may create a structural incentive toward verbalization that risks interfering with tacit, nonanalytical expert judgment. The downstream consequences include directional distortion of the clinical record, reduced detection of premature diagnostic closure, and the potential erosion of trainees’ appreciation for preverbal expertise. Health systems should therefore evaluate ambient scribes for reasoning fidelity rather than transcription accuracy alone, and medical educators should teach the distinction between tacit judgment and bias. Ambient scribes solve a real problem, but documentation systems built around what can be heard may gradually devalue clinical reasoning that cannot be spoken.
Chronic kidney disease (CKD) is an important risk factor for cardiovascular events, yet performance of cardiovascular prediction models are understudied in the CKD population, including women with CKD. To investigate the performance of multiple cardiovascular prediction models, the Framingham, Adult Treatment Panel (ATP) III, ACC/AHA Pooled Cohort Equations (PCE), QRISK3, and PREVENT models, in women with and without CKD. Secondary analysis of a prospective cohort study (Women’s Health Initiative Biomarker Studies). 21,548 postmenopausal women ages 50–79 without cardiovascular disease, including 1,095 with CKD defined by eGFR < 60 mL/min per 1.73 m2. Model discrimination by C-statistic. Calibration by clinically relevant decision-making thresholds. Included events varied by model: Framingham model outcomes included myocardial infarction (MI), angina, or coronary heart disease (CHD) death; ATP III model outcomes included fatal and nonfatal CHD; PCE and PREVENT model outcomes included CHD or ischemic stroke; QRISK3 model outcomes included CHD, stroke, or transient ischemic attack. Number of cardiovascular events varied based on outcome definition. For the non-CKD group, events ranged from 846 (4.1
Chronic pain, opioid use disorder (OUD), and opioid misuse (OM) often appear as co-occurring conditions; however, they are infrequently treated simultaneously which may lead to worse health outcomes. A novel way to manage these co-occurring conditions is by using a pain self-management (PSM) approach, which focuses on changing behavior through mechanisms that focus on self-regulation. Behavioral interventions, such as PSM, are a safe and effective approach to chronic pain treatment and have the highest likelihood of impact when they are tailored to the target population and setting. The purpose of this study was to determine how to tailor PSM for patients with co-occurring chronic pain and OUD/OM. Qualitative study, pragmatic clinical trial. Patients with chronic pain and OUD/OM (N = 31) and clinicians/staff (N = 15) from primary care settings in Pennsylvania and West Virginia were interviewed to gather information needed to develop and tailor a PSM intervention. Pain self-management. Interviews were predominantly conducted remotely and addressed thoughts about pain, pain management, and the usefulness of behavioral interventions. Interviews were transcribed verbatim and coded using an inductively developed codebook; upon completion of coding, conventional content and thematic analysis was conducted. Results of participant interviews included key takeaways such as the risks of long-term opioid therapy, lack of pain self-efficacy, and the complex patient-provider relationships that arise during treatment of these co-occurring conditions. Clinicians/staff interviews discussed social determinants of health and stigma that can hinder clinicians from providing proper care. The qualitative findings described from this pragmatic clinical trial allowed for the precise formulation of a PSM intervention that specifically targets patients with chronic pain and OUD/OM and may be relevant to the future development of other psychosocial-based interventions.
