Journal of General Internal Medicine最新文献

{"title":"Serving Vietnam Veterans Hospitalized Outside the VA System: A Scoping Review of Presumptive Service-Related Illnesses and Presentations.","authors":"Robert Miller, Attila Nemeth, J Luke Taggart, Mary Ann Kirkconnell Hall, Joyce Akwe","doi":"10.1007/s11606-025-09601-8","DOIUrl":"https://doi.org/10.1007/s11606-025-09601-8","url":null,"abstract":"<p><strong>Background: </strong>Recent legislation, the MISSION Act and the PACT Act, expanded access to and utilization of non-Department of Veterans Affairs (VA) health care; more Veterans now receive care from non-VA healthcare providers. Hospitalists outside the VA may be less familiar with Veterans' service-related exposures and presumptive service-related conditions. We aimed to summarize research findings on service-related exposures and conditions among Vietnam War Veterans.</p><p><strong>Methods: </strong>Using Arksey and O'Malley's methodological framework for scoping reviews, we searched PubMed, EMBASE, and Web of Science databases in June 2023. References were imported into EndNote and screened using Covidence collaborative review software. Two reviewers assessed eligibility, with disagreements resolved by a third, then one extracted data. We included papers published in 1998 or later focused on US Vietnam Veterans, excluding genetic/modeling studies, study protocols, case reports/series, clinical trials, and papers without relevance to hospital medicine.</p><p><strong>Results: </strong>We identified 1185 papers; 251 were duplicates, 450 were excluded through title/abstract review, and 335 were excluded after full-text review. A total of 149 studies were included. The exposures mentioned most frequently were Agent Orange/unspecified herbicides (n = 55), violence/combat (n = 14), and infectious disease (n = 9). The most common conditions were PTSD (n = 39), neuropsychiatric conditions (n = 35), cancer (n = 19), metabolic/endocrine disease (n = 11), and neurological dysfunction (n = 11). Overall mortality was addressed in 13 studies.</p><p><strong>Conclusions: </strong>The current literature highlights numerous service-related exposures and conditions recognized by the VA, which may assist hospitalists caring for Vietnam Veterans outside the VA.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078299","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":"Connect Care Project, Bridging the Gap Between Acute and Post-Acute Care.","authors":"Housam Hegazy, Koh-Eun Narm, Brian Pratt, Tiffany Bell, James Mangano, Tara Mathews, Sakshi Dutta, Christopher P Morley, Alyssa M Indelicato, Ilona Chepak, Harvir Singh Gambhir, Zachary Shepherd, Amy Tucker","doi":"10.1007/s11606-025-09598-0","DOIUrl":"https://doi.org/10.1007/s11606-025-09598-0","url":null,"abstract":"<p><strong>Background: </strong>Hospitals in the USA face increasing challenges with access and capacity, prompting strategies to optimize resources, enhance throughput, and improve patient care access.</p><p><strong>Objective: </strong>This study assesses the impact of an innovative clinic-based ambulatory service as an alternative to hospital-based outpatient care, including observation stays and emergency department (ED) follow-up.</p><p><strong>Setting and participants: </strong>A retrospective review of observation-status medical admissions from March 2020 to April 2023 at SUNY Upstate University Hospital. Patients presented to the SUNY Upstate ED.</p><p><strong>Program description: </strong>The Connect Care Project (CCP) introduced an ED-based hospitalist triage team and a hospitalist-led Connect Care (CC) clinic. The triage team identified ED patients needing expedited outpatient workup or close monitoring and follow up. Instead of hospital observation or ED follow up, these patients were referred to the CC clinic for needed workup, close monitoring, or follow-up.</p><p><strong>Program evaluation and results: </strong>Admissions under observation were compared 13 months before and after CCP implementation (November 2021). Chest pain, a common observation reason, was closely analyzed. Of 305,207 ED visits, observation admissions -especially for chest pain -significantly declined after CCP implementation.</p><p><strong>Discussion: </strong>The CCP model improved capacity, reduced cost, and streamlined patient flow. It is adaptable for broader implementation.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078284","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":"The Effect of Early Warning Systems for Sepsis on Mortality: A Systematic Review and Meta-analysis.","authors":"Samer Ein Alshaeba, Elizabeth A Marhoffer, Jürgen L Holleck, Jesse Theisen-Toupal, Alyssa A Grimshaw, Craig G Gunderson","doi":"10.1007/s11606-025-09569-5","DOIUrl":"https://doi.org/10.1007/s11606-025-09569-5","url":null,"abstract":"<p><strong>Background: </strong>The Surviving Sepsis Campaign strongly recommends that all hospitals screen for sepsis as part of performance improvement. The effect of screening for sepsis on mortality, time to antibiotics, and length of stay is uncertain.</p><p><strong>Methods: </strong>A systematic literature search was conducted using Cochrane Library, Google Scholar, Ovid Embase, Ovid Medline, Scopus, and Web of Science Core Collection from earliest entry to June 1, 2024. We included all randomized controlled studies of any type of alert system to screen adult patients for sepsis. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Outcomes were pooled using random effects meta-analysis. Strength of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.</p><p><strong>Results: </strong>In total, we found 7 studies of 3409 patients with sepsis. The pooled odds ratio for mortality for patients randomized to early warning systems was 0.84 (95% CI, 0.60, 1.18). The average time to antibiotics was reported in 4 studies and found to be 0.08 h faster in the screening group (95% CI, - 0.44, 0.28). Length of stay was reported in 4 studies and found to be 0.27 days less in the screening group (95%, - 1.21, 0.66). All differences were non-significant. Overall strength of evidence was low due to risk of bias and imprecision.</p><p><strong>Conclusions: </strong>Based on the current body of randomized controlled studies, there is insufficient evidence to recommend screening for sepsis. Guidelines should reconsider current recommendations for screening for sepsis.</p><p><strong>Prospero registration: </strong>CRD42024563222.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024900","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: Opportunities for General Internal Medicine to Promote Equity in Obesity Care.","authors":"Ryan M Kane, Jacinda M Nicklas, Jessica L Schwartz, Carolyn T Bramante, William S Yancy, Kimberly A Gudzune, Melanie R Jay","doi":"10.1007/s11606-025-09504-8","DOIUrl":"10.1007/s11606-025-09504-8","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020410","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":"Providers' Role in Building Patient Buy-In for Treating Chronic Pain and PTSD: Veterans' Perspectives on Interactions with Providers.","authors":"Nicole L Johnson, Jennifer Van Tiem, Kenda Stewart Steffensmeier, Suzanne Akuley, Daniel Ball, Emily B K Thomas, Michelle Mengeling, Sonya Norman, Alessandra A Pratt, Mary A Driscoll, Lauren A Garvin, Kimberly J Hart, Katherine Hadlandsmyth","doi":"10.1007/s11606-025-09588-2","DOIUrl":"https://doi.org/10.1007/s11606-025-09588-2","url":null,"abstract":"<p><strong>Background: </strong>Patients with co-occurring chronic pain and PTSD are especially vulnerable to debilitating symptoms and frustrating experiences seeking healthcare. The complicated nature of the health conditions and their treatments present a challenge for providers to communicate their treatment recommendations and rationale.</p><p><strong>Objective: </strong>This qualitative study explored Veterans' views on communication with their providers during clinical visits related to their chronic pain and PTSD treatments, so that we may understand their experiences and identify opportunities to improve clinical communication and patient satisfaction.</p><p><strong>Design: </strong>Semi-structured interviews with the interview guide finalized based on feedback from a Veteran engagement panel.</p><p><strong>Participants: </strong>Veterans diagnosed with chronic pain and PTSD who receive care from Veterans Health Administration.</p><p><strong>Approach: </strong>Inductive thematic analysis to characterize how Veterans describe interactions with providers treating their chronic pain and PTSD.</p><p><strong>Key results: </strong>Providers' communication influences Veterans' perceptions in three ways: (a) when Veterans expressed satisfaction with their provider, they described their gratitude for learning about their options; (b) when Veterans expressed dissatisfaction, it often represented a lack of mutual understanding or knowledge of the provider's rationale; and (c) inaccurate information on electronic medical records perpetuated a distrustful environment.</p><p><strong>Conclusions: </strong>Breakdowns occur when Veterans are unsure of their providers' rationale and our data underscore the importance of clear communication in establishing trust and optimizing care for Veterans with PTSD and chronic pain. As the interplay between chronic pain and PTSD symptoms takes centerstage in clinical innovations, providers must consider how best to educate their patients and explain their rationale for recommendations. Trauma-informed strategies may be especially valuable for delivering care to an inordinately vulnerable population.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004636","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":"Theoretical considerations of the Reporter-Interpreter-Manager-Educator Assessment Framework.","authors":"Dario Torre, Paul A Hemmer, Steven J Durning, Louis N Pangaro","doi":"10.1007/s11606-025-09580-w","DOIUrl":"https://doi.org/10.1007/s11606-025-09580-w","url":null,"abstract":"<p><strong>Issue: </strong>The Reporter-Interpreter-Manager-Educator assessment framework provides a concise approach to observing learner progress in clinical settings. Despite its widespread use and study, its theoretical underpinnings remain unexplored.</p><p><strong>Evidence: </strong>We identify two key principles and concepts of the Reporter-Interpreter-Manager-Educator (RIME) framework and their underlying theoretical explanations for it. (1) Categorization and prototype theory: RIME allows categorization of the learner, using previously internalized prototypes belonging to a \"category membership\" (Reporter-Interpreter-Manager/Educator; Story-Observations-Assessment-Plan) which depend on pattern recognition. (2) Theories of cognitive development enabling its \"developmental\" perspective: the progress of roles in RIME is a series of zone of proximal development (ZPD) challenges in which the teacher and learner identify boundaries of the ZPD, recognize the gap between the actual and the potential development, and provide specific recommendations to foster learners' advancement. Similarly, in a community of practice, learners progress from peripheral to full participation within their community and engage in a meaningful learning process.</p><p><strong>Implications: </strong>RIME is a theory-based framework facilitating the assessment of learners in the clinical setting. RIME's theoretical tenets facilitate its use to navigate current tensions in assessment, while offering insights into its integration with other assessment models and theoretical frameworks.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974522","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":"From Compassion Fatigue to Connection: The Role of Story and Art in Healthcare.","authors":"Andrew Mohama, Samantha Shih, Jay Behel","doi":"10.1007/s11606-025-09587-3","DOIUrl":"https://doi.org/10.1007/s11606-025-09587-3","url":null,"abstract":"<p><p>Storytelling is often overlooked in medical education, yet it is fundamental to patient-centered care, clinical reasoning, and physician well-being. At RUSH Medical College, we have developed three storytelling-based initiatives-museum-based engagement, Restorative Justice (RJ) circles, and live storytelling events-that cultivate key skills in observation, communication, and emotional intelligence. Though these programs emerged independently, they now represent a broader movement to integrate narrative-based learning into medical education. Too often, storytelling and the humanities are \"weakly included\" in training rather than embedded as essential competencies. However, we believe narrative medicine improves cultural competence, strengthens trust, and enhances physicians' ability to cope with stress. By formalizing storytelling as a structured component of medical education, we envision more empathetic clinicians and a more humane healthcare experience. We call on medical educators and leaders to move beyond viewing storytelling as an \"extra\" and instead recognize its role as a clinical skill essential to the future of medical practice.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999795","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":"The Rise of Clinical Decision Support Algorithms in Pain Management 2009-2024.","authors":"Dan Kabella, Dorie Apollonio, Halle Young, Kelly R Knight","doi":"10.1007/s11606-025-09600-9","DOIUrl":"https://doi.org/10.1007/s11606-025-09600-9","url":null,"abstract":"<p><p>This paper examines the rise of clinical decision support algorithms used to assess risk in pain management and the opioid industry's influence on their development and implementation. To understand this influence, we conducted a qualitative study of documents related to the development of a tool that relied on artificial intelligence (AI) to suggest modifications in opioid prescribing, called NarxCare. The study began with keyword searches of the Opioid Industry Document Archive (OIDA), which contained over 3 million documents at the time of the study, to examine the pharmaceutical industry's role in shaping the digital transformation of opioid prescribing. Our findings highlight industry-driven investments, educational campaigns, corporate policy activities, and the reliance on proprietary data that facilitated the widespread implementation of NarxCare. The increasing reliance on NarxCare raises concerns about its limited transparency, unknown reliability, and potential bias which may disproportionately affect certain patient groups based on race, socioeconomic status, or health conditions. This paper argues that the promotion of technologies like NarxCare allows the pharmaceutical industry to reinforce the narrative that opioids can be effective when prescribed responsibly, using advanced, data-driven strategies. Marketed as tools that assist clinicians in making more informed prescribing decisions, NarxCare contributes to the portrayal of the industry as a responsible actor in the regulation and distribution of opioids. Shifting attention to individual risk factors rather than systemic challenges enables the pharmaceutical industry to sidestep its role in the opioid crisis and evade scrutiny for its influence over regulation, the sponsorship of education and research, lobbying, supply chain control, and public health narratives. While NarxCare aims to improve prescribing safety, it requires critical evaluation in terms of effectiveness, ethical considerations, and the continued influence of the pharmaceutical industry in its design and implementation.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020413","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":"\"Cross-Pollinating Expertise\": Collaborative Educational Sessions for Emergency and Internal Medicine Residents.","authors":"Ryan Clark, Kathryn Jobbins, Ashley Deutsch, Christine Bryson","doi":"10.1007/s11606-025-09536-0","DOIUrl":"https://doi.org/10.1007/s11606-025-09536-0","url":null,"abstract":"<p><strong>Background: </strong>Medical Education between residencies remains siloed. Once residents have chosen their career track, they often lack opportunities to learn with residents in other disciplines. However, residents care for patients in a continuous fashion as they navigate the healthcare system. We created an annual educational session for Internal Medicine and Emergency Medicine residents to learn together about common medical problems they encounter.</p><p><strong>Aim: </strong>Readers will: 1. describe the benefits of participating in interdisciplinary resident education, 2. increase confidence in how to improve interdisciplinary communication, and 3. improve ability to plan and implement interdisciplinary education among residencies.</p><p><strong>Setting: </strong>An independent academic medical center in western Massachusetts.</p><p><strong>Participants: </strong>Internal Medicine (54), Medicine/Pediatrics (32), and Emergency Medicine (48) residents.</p><p><strong>Program description: </strong>Leadership from both residencies identified high yield topics that would provide optimal opportunities to collaborate about patient care and hand offs.</p><p><strong>Program evaluation: </strong>Resident evaluations highlighted positive feedback, indicating improved understanding and desire for continued collaboration. Thematic analysis revealed enhanced collegiality and a preference for small-group, case-based learning.</p><p><strong>Discussion: </strong>Instituting yearly combined education amongst residencies can enhance collegiality and allow opportunities to enhance patient care during transitions from primary care, emergency care and hospitalization. Implementing shared education enhances resident interaction and potentially improves patient care transitions.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973788","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":"Public Views of Health Care Coverage, Spending, and Leadership in the United States.","authors":"Sudheesha Perera, Dhruv Khullar, Rishi Wadhera","doi":"10.1007/s11606-025-09596-2","DOIUrl":"https://doi.org/10.1007/s11606-025-09596-2","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020411","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}