Journal of General Internal Medicine最新文献

{"title":"Racial Disparities in Hesitancy and Utilization of Monoclonal Antibody Infusion Treatment of COVID-19: Lessons for Future Pandemics.","authors":"Yahya Shaikh, Ishaan Gupta, Sophia Purekal, Mary Jane E Vaeth, Maisha Foyez, Charles D Callahan, Maryam Elhabashy, Minahil Cheema, Resham Rahat, James R Ficke, Albert W Wu, Paul G Auwaerter, Melinda E Kantsiper, Zishan K Siddiqui","doi":"10.1007/s11606-025-09386-w","DOIUrl":"https://doi.org/10.1007/s11606-025-09386-w","url":null,"abstract":"<p><strong>Background and methods: </strong>We conducted a single-center cross-sectional study to investigate racial disparities in the hesitancy and utilization of monoclonal antibody (mAb) treatment of COVID-19 among treatment eligible patients who were referred to the infusion center between January 4, 2021, and May 14, 2021.</p><p><strong>Results: </strong>Among the 2406 eligible participants, mAb treatment was significantly underutilized among African American patients compared to White patients (OR 1.8; 95% CI 1.5-2.1). The higher proportion of refusals and cancellations of mAb treatment may suggest a higher level of hesitancy among African American patients (OR 1.7; 95% CI 1.3-2.1).</p><p><strong>Conclusion: </strong>Evaluating the reasons and addressing racial disparities in hesitancy of novel therapeutics under Emergency Use Authorization (EUA) offer a critical opportunity to address the inequities in pandemic care.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516007","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 Impact of COVID-19 on US Academic Medical Centers: Implications for General Medicine Service Lines.","authors":"Natalie Caylor, David W Walsh, Ding Xie, Jennifer L Waller, Thad Wilkins","doi":"10.1007/s11606-025-09439-0","DOIUrl":"https://doi.org/10.1007/s11606-025-09439-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501678","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":"Opioid Treatment Programs and Risks for COVID-19 Infections, Emergency Visits, and Hospitalizations.","authors":"Ryan R Cook, Kendra L Blalock, Sanae El Ibrahimi, Kim Hoffman, Ximena A Levander, Kacey Little, Gillian Leichtling, P Todd Korthuis, Dennis McCarty","doi":"10.1007/s11606-025-09444-3","DOIUrl":"10.1007/s11606-025-09444-3","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic spurred relaxation of opioid treatment program (OTP) in-person daily dosing requirements. This policy change was met with widespread enthusiasm by patients and providers and did not increase illicit opioid use, overdose, or medication diversion. However, it is not known whether the policy change was effective at mitigating the COVID-19 public health emergency among people with opioid use disorder (OUD) receiving treatment at OTPs.</p><p><strong>Objective: </strong>To evaluate the impact of treatment at OTPs on rates of COVID-19 infections and complications.</p><p><strong>Design: </strong>Prospective cohort from 4/1/2020 to 3/31/2021.</p><p><strong>Participants: </strong>Oregon Medicaid beneficiaries with an OUD diagnosis.</p><p><strong>Main measures: </strong>The exposure was time-varying treatment for OUD, including (1) medication treatment at an OTP, (2) office-based opioid medication treatment (OBOT), (3) other treatment without medications for OUD, or (4) no treatment. Outcomes were COVID-19 diagnoses, COVID-related emergency department visits, and COVID-related hospitalizations.</p><p><strong>Results: </strong>Participants (N = 24,654) averaged 39 years old, most were female (53%), White (84%), and non-Hispanic (88%). Adjusted for characteristics and comorbidities, OTP patients demonstrated significantly reduced risk of COVID-19 diagnoses compared to all other groups: a 37% reduction compared to OBOT, a 52% reduction compared to non-MOUD treatment, and a 37% reduction compared to no OUD treatment. OTP treatment was also associated with a 40% risk reduction of COVID-related ED visits compared to OBOT, a 56% reduction compared to non-MOUD treatment, and a 46% risk reduction compared to no treatment. For inpatient stays, there was not a significant difference between OTP and OBOT treatment or no treatment, but OTP treatment was associated with a 64% risk reduction compared to non-MOUD treatment.</p><p><strong>Conclusions: </strong>Lower risks of COVID-19 diagnoses and complications were observed among people with OUD receiving treatment at OTPs compared to other forms of treatment or no treatment.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501585","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 Moderating Effects of Moral Injury and Discrimination Trauma on Women Physician Trainees' Well-Being.","authors":"Pari Thibodeau, Grace N Bosma, Camille J Hochheimer, Adnan Syed, Nathalie Dieujuste, Adrienne Mann, Tyra Fainstad","doi":"10.1007/s11606-025-09434-5","DOIUrl":"https://doi.org/10.1007/s11606-025-09434-5","url":null,"abstract":"<p><strong>Background: </strong>Graduate medical trainees are positioned to experience high rates of negative well-being due to the demanding and hierarchical nature of this time in their careers. Focusing on the well-being of physician trainees is required to ensure a better future of medicine. A novel avenue of examining physician trainee well-being is through understanding the effects of moral injury and discrimination trauma in overall well-being.</p><p><strong>Objective: </strong>This secondary data analysis examines the moderating role of discrimination trauma and moral injury on six well-being metrics cross-sectionally at baseline and 4 months postcoaching intervention, respectively.</p><p><strong>Design: </strong>This is a secondary, cross-sectional analysis using survey data collected at two time points.</p><p><strong>Participants: </strong>The participants in this study (n = 1017) are women physician trainees in the USA.</p><p><strong>Main measures: </strong>The predictor measures are as follows: Moral Injury Symptom Scale- Healthcare Providers and Trauma Symptoms of Discrimination Scale. The outcome measures are as follows: Maslach's Burnout Inventory, Young Impostor Scale, Self-Compassion Scale, and Secure Flourishing Index.</p><p><strong>Key results: </strong>At baseline, discrimination trauma moderates the relationship among moral injury with impostor syndrome and self-compassion. After the coaching intervention, moral injury moderates the effect of the intervention on impostor syndrome.</p><p><strong>Conclusions: </strong>The results of this secondary analysis emphasize the role moral injury and discrimination play in overall well-being, specifically through the experiences of self-compassion and impostor syndrome. This study calls for early measurement and mitigation efforts of both moral injury and discrimination trauma, which may effect well-being for graduate medical trainees and lessen the impact of our coaching intervention.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501685","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 Novel Automated Algorithm to Identify Lung Cancer Screening from Free Text of Radiology Orders.","authors":"Alison S Rustagi, Marzieh Vali, Francis J Graham, Emily N Lum, Christopher G Slatore, Salomeh Keyhani","doi":"10.1007/s11606-025-09429-2","DOIUrl":"https://doi.org/10.1007/s11606-025-09429-2","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer screening (LCS) is recommended for asymptomatic patients. Administrative codes for LCS may capture tests prompted by signs/symptoms.</p><p><strong>Objective: </strong>To validate an automated algorithm that identifies LCS among asymptomatic patients.</p><p><strong>Design: </strong>In this cross-sectional study, an algorithm was iteratively developed to identify outpatient low-dose chest CT scans via Current Procedural Terminology (CPT) codes, search free text of radiology orders for screening terms and signs/symptoms (e.g., cough), and classify scans as screening or not.</p><p><strong>Participants: </strong>National population-based sample of 4503 adults ages 65-80 in Veterans Health Affairs primary care, with detailed smoking history to identify LCS-eligible individuals (30 + pack-years, current tobacco use, or quit < 15 years prior).</p><p><strong>Main measures: </strong>Algorithm specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) relative to manual chart review (gold standard) on 100% of screening scans and > 10% random sample of non-screening scans.</p><p><strong>Key results: </strong>Chart review was conducted on n = 335 scans. The final algorithm could not classify 22% of scans, of which 73% were non-screening; these were excluded from primary analyses. Among 842 LCS-eligible individuals, the algorithm demonstrated 97% sensitivity (95%CI 91-99%) and 79% specificity (58-93%). Only 69% (61-77%) of scans classified as LCS via administrative codes were truly screening, compared to 95% of those classified as screening via the algorithm (p < 0.001). Algorithm performance was similar regardless of LCS eligibility, with 90% PPV (84-94%) and 93% NPV (86-97%) in the overall population regardless of tobacco cigarette history.</p><p><strong>Conclusions: </strong>An automated algorithm can accurately identify screening versus diagnostic chest imaging, a necessary step to unbiased analyses of LCS in non-randomized settings. Studies should assess the accuracy of administrative codes for LCS in other health systems.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501968","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":"On Going Soft.","authors":"Hannah Decker","doi":"10.1007/s11606-024-09047-4","DOIUrl":"https://doi.org/10.1007/s11606-024-09047-4","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500900","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":"Training International Medical Graduate Internal Medicine Residents in Pelvic Examinations and Pap Smears.","authors":"Kristin A Swedish, Nicholas D Tyau, Nikolina Icitovic, Eva E Metalios","doi":"10.1007/s11606-025-09446-1","DOIUrl":"https://doi.org/10.1007/s11606-025-09446-1","url":null,"abstract":"<p><strong>Background: </strong>Nearly 39% of Internal Medicine (IM) residents in American training programs are international medical graduates (IMGs), whose prior training in women's health is variable. There is a paucity of data about women's health training programs that train IMG IM residents in pelvic examinations/Pap smears.</p><p><strong>Aim: </strong>To train IMG IM residents to competently perform pelvic examinations/Pap smears.</p><p><strong>Setting: </strong>Montefiore Wakefield IM residency clinic, Bronx NY.</p><p><strong>Participants: </strong>IMG categorical IM residents.</p><p><strong>Program description: </strong>In 2015, we established the Women's Health Clinic (WHC) to train residents in pelvic examinations/Pap smears. The educational model includes one hour of didactics followed by trainees seeing up to four patients, supervised by WHC faculty in 1:2 preceptor to resident ratio.</p><p><strong>Program evaluation: </strong>We evaluated the impact of WHC on IMG residents' self-reported competence in performing pelvic examinations/Pap smears by using McNemar's test to compare self-reported competence in pelvic examinations and Pap smears before and after WHC participation.</p><p><strong>Discussion: </strong>WHC improved self-reported competence among IMG residents by utilizing standardized didactics reinforced through immediate and repeated patient interactions. It is an educational model that could be reproduced by other IM programs to improve training for IMG residents.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501723","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":"Evaluation of Outpatient Procedures Simulation Curriculum for Internal Medicine Residents.","authors":"Sudipta Mohanty, Aditya Mohanty, Joséphine A Cool, Daniel N Ricotta","doi":"10.1007/s11606-025-09394-w","DOIUrl":"https://doi.org/10.1007/s11606-025-09394-w","url":null,"abstract":"<p><strong>Background: </strong>Outpatient procedure training in internal medicine residency has not been shown to produce high-level outcomes such as improved volume and quality of procedures performed on real patients.</p><p><strong>Objective: </strong>The objective of this study was to improve the volume and quality of outpatient procedures performed by internal medicine residents by administering a simulation-based curricular intervention.</p><p><strong>Design: </strong>Validated teaching materials and local faculty input were used to design a simulation curriculum for teaching the knee joint injection/aspiration and skin abscess incision and drainage. A prospective curricular intervention was implemented for a single cohort of internal medicine interns.</p><p><strong>Participants: </strong>All internal medicine interns at Beth Israel Deaconess Medical Center during the 2021-2022 academic year were allowed to participate in this educational intervention with no exclusion criteria.</p><p><strong>Interventions: </strong>Forty-seven interns received 30 min of simulation education for each procedure.</p><p><strong>Main measures: </strong>Primary outcomes included total number of procedures performed in clinic, volume of procedures performed by residents, percentage of total procedures performed by residents, and procedural success and complication rates before and after the curricular intervention.</p><p><strong>Key results: </strong>At 1-year post-curriculum, the total number of procedures in clinic increased by 25%. Procedures by residents increased by 110%, with joint injections/aspirations increasing by 317% and skin abscess incision and drainage increasing by 200%. Complication rates reduced from 25 to 0%, and 100% of resident-performed procedures post-curriculum were completed successfully.</p><p><strong>Conclusion: </strong>These findings demonstrate that a novel outpatient procedures simulation curriculum can positively impact higher-level clinical practice outcomes for internal medicine residents.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501970","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":"Impact of Pre-Existing Disability on Long-Term Health Care Use Following Hospitalization for COVID-19: A Population-Based Cohort Study.","authors":"Hilary K Brown, Thérèse A Stukel, Hannah Chung, Samantha Lee, Yona Lunsky, Chaim M Bell, Pavlos Bobos, Angela M Cheung, Allan S Detsky, Susie Goulding, Margaret Herridge, Fahad Razak, Amol A Verma, Kieran L Quinn","doi":"10.1007/s11606-025-09396-8","DOIUrl":"https://doi.org/10.1007/s11606-025-09396-8","url":null,"abstract":"<p><strong>Background: </strong>Emerging evidence shows the lasting impact of SARS-CoV-2 infection on health care use and needs. Policy-makers require data on population-level service use to understand patient needs and health system impacts following hospitalization for COVID-19.</p><p><strong>Objective: </strong>To compare health service use within 12 months following hospitalization for COVID-19 among people with and without pre-existing disabilities, and to determine the extent to which such use is related to disability and other risk factors.</p><p><strong>Design: </strong>Population-based cohort study, Ontario, Canada.</p><p><strong>Participants: </strong>Adults with and without disabilities hospitalized for COVID-19, 01/25/2020-02/28/2022.</p><p><strong>Main measures: </strong>We used Poisson regression to model adjusted rate ratios (aRR) of ambulatory care visits, diagnostic testing, emergency department (ED) visits, hospital admissions, and palliative care visits within 1-year post-discharge, comparing patients with and without disabilities. Models were adjusted sequentially for sociodemographic factors, comorbidities, and prior health service use. The importance of each set of covariates in its ability to explain observed associations was determined by calculating relative changes in disability parameter coefficients after each sequential risk-adjustment.</p><p><strong>Key results: </strong>The cohort included 25,320 patients with disabilities and 15,953 without. In the year after hospitalization for COVID-19, people with disabilities had higher rates of ambulatory care visits, diagnostic tests, ED visits, hospital admissions, and palliative care visits. A significant proportion of these associations was explained by sociodemographic factors, comorbidities, and prior health service use. However, adjusted relative rates associated with disability remained elevated, even after adjustment, for ambulatory care visits (aRR 1.09, 95% CI 1.08, 1.10), diagnostic tests (aRR 1.14, 95% CI 1.12, 1.16), ED visits (aRR 1.25, 95% CI 1.21, 1.29), and hospital admissions (aRR 1.21, 95% CI 1.16, 1.29).</p><p><strong>Conclusions: </strong>These findings support the need to develop and evaluate models of care for the post-COVID-19 condition that address the needs of people with disabilities.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501971","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":"Safe, Then Sorry? - The Psychological Biases that Drive Care Cascades.","authors":"Nicholas E Daley, Meredith B Rosenthal, Ishani Ganguli","doi":"10.1007/s11606-025-09442-5","DOIUrl":"https://doi.org/10.1007/s11606-025-09442-5","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501677","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}