Journal of General Internal Medicine最新文献

{"title":"Systematic Review: Association Between Physicians' Clinical Experience and Quality of Care and Patient Outcomes.","authors":"Mitsuhiro Shimada, Toshiki Kuno, Yu Shindo, Masao Iwagami, Yusuke Tsugawa","doi":"10.1007/s11606-026-10403-9","DOIUrl":"https://doi.org/10.1007/s11606-026-10403-9","url":null,"abstract":"<p><strong>Background: </strong>Physicians with longer clinical experience may accumulate, or conversely exhibit obsolescence of, clinical knowledge and skills.</p><p><strong>Objective: </strong>This systematic review aims to summarize current evidence of the impact of physician experience on quality of care and patient outcomes.</p><p><strong>Methods: </strong>We conducted a systematic review by searching EMBASE and MEDLINE databases from 2005 to 2025. Studies were included if they evaluated an association between physician experience-either length of practice or age-and quality of care and patient outcomes (i.e., knowledge, adherence to standard of care, and clinical outcome).</p><p><strong>Results: </strong>We included 69 studies. Overall, 32 (46%) of 69 studies showed that physicians' experience or age has a negative impact on the quality of care and patient outcomes, whereas 16 (23%) studies reported a positive impact of experience or age. The negative impact of physician experience was observed in the knowledge and adherence to the standard of care domains: 12 (52%) of 23 studies in the knowledge domain and 14 (61%) of 23 studies in the adherence domain showed a negative effect of experience or age. We found mixed findings for clinical outcomes; six (26%) of 23 studies reported negative and nine (39%) reported positive associations. These relationships were consistent when we limited the studies with low or moderate risk of bias as well as moderate or low certainty of evidence.</p><p><strong>Conclusions: </strong>The older age and increased experience of physicians were associated with inferior knowledge and less adherence but not correlated with clinical outcomes.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight Reduction Advice by Physicians for Obese Patients in Office-Based Settings in the USA: An Observational Study.","authors":"Muni Rubens, Venkataraghavan Ramamoorthy, Anshul Saxena, Ashley Rodriguez, Brian Murillo, Krimal Shah, Charlotte Tudela, Elise McCormack-Granja","doi":"10.1007/s11606-026-10489-1","DOIUrl":"https://doi.org/10.1007/s11606-026-10489-1","url":null,"abstract":"<p><strong>Background: </strong>Obesity prevention guidelines have stressed the importance of utilizing each patient-physician encounter towards delivering effective weight reduction, exercise, and dietary counseling during patient encounters. The objective of this study was to understand the prevalence and predictors of weight, exercise, and dietary counseling for obese adults using a nationally representative data.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional analysis of the National Ambulatory Medical Care Survey (2011-2018), of obese patients aged ≥ 18 years who had an office visit. Outcomes were receipt of weight reduction, exercise, dietary, any, and all counseling. Descriptive statistics and multivariable logistic regression were used to identify demographic, clinical, and practice-related predictors. Sampling weights were used to generate national estimates.</p><p><strong>Results: </strong>An estimated 289,667,549 office visits were found among obese adults during the study period. Nearly 21.5% of these office visits had weight reduction advice, 24.5% exercise counseling, 33.9% dietary counseling, 40.1% any counseling, and 12.2% all three counseling. Logistic regression analysis showed that the odds of receiving any type of advice were significantly higher among Blacks (OR 1.43, 95% CI 1.11-1.85), Hispanics (OR 1.48, 95% CI 1.03-2.14), those with hyperlipidemia (OR 1.82, 95% CI 1.45-2.29), chronic problems (OR 1.84, 95% CI 1.44-2.35), and those seeking preventive care (OR 1.67, 95% CI 1.28-2.18), whereas lower among those who were ≥ 65 years (OR 0.68, 95% CI 0.49-0.95). The odds of receiving all types of advice were significantly higher among Hispanics (OR 2.02, 95% CI 1.09-3.73), those with chronic problems (OR 2.00, 95% CI 1.41-2.84), and those seeking preventive care (OR 1.76, 95% CI 1.21-2.56), and those whose physicians were also their primary care providers (OR 1.06, 95% CI 1.21-3.53).</p><p><strong>Conclusions: </strong>Weight-related counseling remains infrequent in US primary care settings, particularly for older adults and those with comorbidities. Strengthening patient-provider relationships and targeting identified gaps could improve obesity management.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing Disparities in GLP-1 Receptor Agonist Use Among US Adults With and Without Diabetes.","authors":"Jasmin Elkin, Cade Shadbolt, Chris Schilling, Michael W Hii, Priya Sumithran, Peter F Choong, Michelle M Dowsey","doi":"10.1007/s11606-026-10506-3","DOIUrl":"https://doi.org/10.1007/s11606-026-10506-3","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing Coagulation Abnormalities, Bleeding, and Thrombosis in Patients with Cirrhosis.","authors":"Armando Tripodi, Vincenzo La Mura, Fabio Piscaglia, Bernardo Stefanini, Nicoletta Riva, Walter Ageno","doi":"10.1007/s11606-026-10478-4","DOIUrl":"https://doi.org/10.1007/s11606-026-10478-4","url":null,"abstract":"<p><p>Cirrhosis is associated with a narrow balance between procoagulant and anticoagulant factors that may lead to potentially serious complications. Interpretation of laboratory tests, prevention of bleeding during invasive procedures, and use of anticoagulant drugs for the prevention and treatment of thromboembolism are often challenging. After reviewing the most contemporary literature, we hereby provide guidance to navigate the evidence and support clinical decisions. Based on current knowledge, prothrombin time and activated partial thromboplastin time do not accurately describe hemostasis in patients with cirrhosis and should not be used to predict bleeding. Rather, a careful assessment of patient and procedure-related variables better helps to identify patients at increased bleeding risk. Because procedure-related bleedings are uncommon in patients with cirrhosis, the use of prophylactic strategies is seldom necessary in daily practice. In case of perioperative bleeding, viscoelastometry may be useful to drive decisions on the use of transfusion products. Portal vein thrombosis is a common complication in patients with cirrhosis and requires a timely start of anticoagulant treatment, especially when vessel obstruction exceeds 50% of the lumen diameter. Treatment should be continued for at least 6 months. The direct oral anticoagulants are increasingly used in this setting, representing a valid alternative to the heparins and vitamin K antagonists. Atrial fibrillation in cirrhosis is associated with a high risk of ischemic stroke and treatment-related major bleeding. The benefit of anticoagulants is supported by the results of observational studies, and the direct oral anticoagulants are suggested as the first line of treatment also for this population. Clinical trial number: not applicable.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: PACE-It: An Integrated Multidisciplinary Technology-Assisted Approach to Person-Centered Care for Individuals with Complex Care Needs.","authors":"Prawira Oka, Zhen Sinead Wang, Pei Lin Hu, Chien Earn Lee, Chirk Jenn Ng","doi":"10.1007/s11606-026-10509-0","DOIUrl":"https://doi.org/10.1007/s11606-026-10509-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fentanyl Is Not a WMD.","authors":"Siddharth Dave, Peter A Goldstein","doi":"10.1007/s11606-026-10499-z","DOIUrl":"https://doi.org/10.1007/s11606-026-10499-z","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transparency of Alpha Omega Alpha Selection Processes and Bias Mitigation Across US Medical Schools: A Cross-Sectional Mixed Methods Study.","authors":"Christine C Cheston, Neeharika Chanda, Sorraya Jaiprasert, Liam F Keohane","doi":"10.1007/s11606-026-10475-7","DOIUrl":"https://doi.org/10.1007/s11606-026-10475-7","url":null,"abstract":"<p><strong>Background: </strong>Membership in the Alpha Omega Alpha (AOA) honor society has long-term professional benefits, including improved match outcomes, yet racial and socioeconomic disparities in membership are well-documented. AOA selection processes across schools lack standardization, complicating understanding of the meaning of membership.</p><p><strong>Objective: </strong>To analyze transparency and methodology of AOA selection processes nationally and describe chapters' acknowledgement of potential for bias.</p><p><strong>Design: </strong>Researchers performed a mixed methods cross-sectional study of medical school websites describing AOA chapter eligibility and selection in the United States (US) from October 2023 to April 2024. Descriptive statistics were generated to characterize quantitative data, and thematic analysis was performed to identify patterns within extracted quotes.</p><p><strong>Subjects: </strong>LCME-accredited, MD-granting medical schools in the US.</p><p><strong>Approach: </strong>Researchers iteratively refined a data extraction form focused on AOA chapter status, eligibility and selection criteria, and quotes acknowledging potential for bias. Both thematic and content analyses were used with extracted quotes, while descriptive statistics were calculated for quantitative data.  KEY RESULTS: Of 157 medical schools nationally, 131 (83%) had an active AOA chapter. Of these, 98 (75%) referenced eligibility and/or selection procedures. Personal characteristics (55%), review of accomplishments (51%), and an academic cut-off (18%) were the most common selection criteria. Twenty-seven schools (17% of all schools, including four with recently closed chapters) acknowledged potential for bias, and eight themes were generated to characterize bias acknowledgement.</p><p><strong>Conclusions: </strong>Most medical school websites described AOA evaluation methods, which were variable across schools. Few schools acknowledged potential for bias. Given these findings, future studies should explore the current interpretation of AOA membership with emphasis on bias mitigation at the residency level and beyond.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Bone Mass, Falls, and Vertebral Fractures in Older Patients on Hemodialysis: The Role of Comprehensive Geriatric Assessment.","authors":"Suzan Abou-Raya, Mohamed Mehanna, Yasser Allam, Khaled Matrawy, Shimaa ElSaied, Anna Abou-Raya","doi":"10.1007/s11606-026-10398-3","DOIUrl":"https://doi.org/10.1007/s11606-026-10398-3","url":null,"abstract":"<p><strong>Background: </strong>End-stage renal disease (ESRD) requiring hemodialysis (HD) disproportionately affects older adults, who face increased risks of falls and fractures due to age-related changes, renal osteodystrophy, comorbidities and dialysis-related factors. Although bone abnormalities and fall risk have often been examined separately in patients with ESRD, few studies have evaluated vertebral compression fractures (VCF) in older HD patients while concurrently assessing skeletal, functional and geriatric risk factors. The role of Comprehensive Geriatric Assessment (CGA) in identifying multidimensional risk factors in this context remains underexplored.</p><p><strong>Objective: </strong>To investigate associations between bone mass, falls and VCF in older adults undergoing HD, and evaluate the utility of CGA in identifying risk factors and informing care strategies.</p><p><strong>Participants: </strong>This cross-sectional study enrolled 50 older adults (≥ 65 years; mean age 67.8 (3.2), range 65-76) with ESRD on maintenance HD. Participants had multiple comorbidities, typical of this population, including anemia, cardiovascular disease and chronic liver disease.</p><p><strong>Main measures: </strong>Bone mineral density was assessed using dual-energy X-ray absorptiometry. Falls, VCF, comorbidities, and medication use were documented via interviews and medical records. CGA included assessments of activities of daily living (ADLs), mobility, cognition, depression, nutrition and social support. FRAX scores and biochemical markers (parathyroid hormone [PTH], bone-specific alkaline phosphatase [ALP]) were analyzed.</p><p><strong>Results: </strong>Falls occurred in 28% of participants, significantly associated with prior fall history (p < 0.001), advanced age (p = 0.011), anemia (p = 0.040), chronic liver disease (p = 0.044), reduced mobility (p = 0.037), depression (p = 0.01), impaired ADLs (p = 0.037) and poor nutrition (p = 0.032). VCF were present in 14%, associated with earlier menopausal age, back pain, elevated ALP and higher FRAX scores. Osteoporosis was most prevalent at the distal radius (46%). Hip T-scores were lower in the VCF group (p = 0.003). PTH and ALP were significantly higher in VCF patients (p = 0.003), indicating impaired bone turnover.</p><p><strong>Conclusion: </strong>Older adults on HD face a substantial burden of falls and vertebral fractures due to overlapping functional, metabolic and psychosocial factors. CGA effectively identified multidimensional risks, underscoring the need for integrated preventive strategies.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reported Knowledge of Recent HbA1c, Blood Pressure, and LDL-cholesterol Levels and Goals Among US Adults with Diabetes-National Health and Nutrition Examination Survey 2011-2020.","authors":"Bharat Poudel, Ligong Chen, Medha J Dubal, Ashley E Christenson, Caroline Presley, Paul Muntner, Michael Fang, Kathryn Foti","doi":"10.1007/s11606-026-10474-8","DOIUrl":"https://doi.org/10.1007/s11606-026-10474-8","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend adults with diabetes should know their hemoglobin A1c (HbA1c), blood pressure (BP), and low-density lipoprotein (LDL)-cholesterol levels and goals.</p><p><strong>Objective: </strong>Determine the proportions of US adults with diabetes who report knowing their HbA1c, BP, and LDL-cholesterol levels and goals as recommended by their doctor or healthcare provider.</p><p><strong>Design: </strong>A cross-sectional analysis of the US adults with self-reported diabetes from 2011-2020 in the National Health and Nutrition Examination Surveys (NHANES).</p><p><strong>Participants: </strong>US adults in NHANES with self-reported diabetes.</p><p><strong>Main measures: </strong>Sociodemographic characteristics including age, sex, race and ethnicity, education, and health insurance coverage were assessed using standardized questionnaires. The outcomes were self-report of knowing HbA1c, BP, and LDL-cholesterol levels and goals. Age-sex-adjusted Poisson regression models with robust variance estimation were used to estimate associations of participant characteristics with each of these outcomes.</p><p><strong>Results: </strong>Among US adults with diabetes included in the analysis (N = 3,464), 58.3% (95% CI: 55.4%-61.2%), 68.3% (95% CI: 65.7%-70.7%) and 18.0% (95% CI: 16.3%-19.8%) reported knowing their recent HbA1c, BP, and LDL-cholesterol levels, respectively, and 53.4% (95% CI: 50.5%-56.2%), 39.7% (95% CI: 37.2%-42.3%), and 13.4% (95% CI: 11.5%-15.6%) reported knowing their HbA1c, BP, and LDL-cholesterol goals, respectively. Non-Hispanic Black and Hispanic versus non-Hispanic White adults, those with less than versus at least a high school education, and those without versus with health insurance were less likely to report knowing their HbA1c, BP, or LDL-cholesterol levels and goals.</p><p><strong>Conclusion: </strong>Low percentages of US adults with diabetes reported knowing their HbA1c, BP, or LDL-cholesterol levels and goals. Understanding reasons for the gaps in knowledge among US adults with diabetes may facilitate interventions to increase risk factor awareness and diabetes self-management behaviors.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Street Medicine Elective in Fostering Compassion and Professional Identity Development in Medical Students: A Qualitative Study.","authors":"Anjie Ge, Nada Abou-Haiba, Hanin Ali, Jordan Holthe, Michelle Kim, Beth Kangas, Adam P Sawatsky","doi":"10.1007/s11606-026-10476-6","DOIUrl":"https://doi.org/10.1007/s11606-026-10476-6","url":null,"abstract":"<p><strong>Background: </strong>Learning how to apply compassion and empathy is a critical skill in medical education. The preclinical medical school curriculum traditionally emphasizes basic science without balanced care-oriented training. Many medical schools have made efforts to increase opportunities for compassion training. However, there are limited studies on the longitudinal impacts and clinical applicability following these interventions. The Zumbro Valley Medical Society Street Medicine elective introduced medical students to a person-centered approach to medicine, particularly for individuals experiencing homelessness, early in medical school.</p><p><strong>Objective: </strong>Explore the effects of the Street Medicine elective on medical students' clinical practice formation and professional identity development.</p><p><strong>Design: </strong>Qualitative study using semi-structured interviews conducted between June 2024 and April 2025.</p><p><strong>Participants: </strong>Twenty-three medical students from Mayo Clinic Alix School of Medicine who participated in the Street Medicine elective were recruited by email and were enrolled in the study.</p><p><strong>Approach: </strong>Interviews were coded and analyzed using a constant comparison method and group discussions with the Reflexive Thematic Analysis framework.</p><p><strong>Results: </strong>Through participation in the Street Medicine elective, medical students reported gaining critical interpersonal skills, enabling them to cultivate trust and relationships with individuals in the community. The elective also increased students' awareness of their own biases, and confidence in their technical skills and professional identities as future physicians. The experiences from the elective prompted students to critically analyze the dominant norms and values of the medical education and healthcare systems. Students recognized how the focus on science over people can prevent compassionate care.</p><p><strong>Conclusion: </strong>The Zumbro Valley Medical Society Street Medicine elective provided compassion training for medical students, with lasting effects on students' skills and professional identities 2 years after they completed the elective. Students recognized and were motivated to challenge the systemic problems that impede patient-centered care.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}