Journal of General Internal Medicine最新文献

{"title":"Medical Student Evaluations of Medical Faculty: Characteristics of Highly and Lower-Rated Teachers.","authors":"Jeffrey L Jackson, Katherine Gavinski, Michelle G Thompson, Derek Storch, Mary G Murphy, Sarah Nickoloff, Akira Kuriyama","doi":"10.1007/s11606-024-09085-y","DOIUrl":"10.1007/s11606-024-09085-y","url":null,"abstract":"<p><strong>Purpose: </strong>Our purpose was to evaluate the characteristics of highly and poorly rated teachers as well as to assess the validity and reliability of those evaluations.</p><p><strong>Methods: </strong>We downloaded 14 years of medicine faculty evaluations completed by 3rd and 4^th year medical students. We dichotomized overall teaching effectiveness as outstanding (receiving \"outstanding\") or inferior (rated as a \"unsatisfactory,\" \"marginal,\" or \"acceptable\"). We analyzed these using logistic regression (STATA v 18.0). We assessed validity and reliability using factor analysis, Cronbach's alpha, and intraclass correlation coefficients.</p><p><strong>Results: </strong>Most (57%) of the 722 faculty members were rated as outstanding. Medical students valued faculty that took advantage of opportunities to teach (OR, 3.0; 95% CI, 2.7-3.3), who were enthusiastic (OR, 2.6; 95% CI, 2.3-2.9), and clear/organized (OR, 2.5; 2.3-2.7). Faculty rarely were rated as inferior (7.7%). Among lower-rated faculty, 91% had more than one lower evaluation. Lower-rated teachers had lower ratings on most domains of evaluation including taking advantages of opportunities to teach (4.6 vs. 2.7, p < 0.0005), being clear and organized (3.0 vs. 4.6, p < 0.0005), enthusiasm (4.5 vs. 2.7, p < 0.0005), being supportive (4.5 vs. 2.5, p < 0.0005), providing feedback (4.4 vs. 2.6, p < 0.005), or clearly answering questions (4.6 vs. 3.1, p < 0.0005). While evaluations were highly consistent (Cronbach's alpha, 0.94), there were low levels of agreement with intraclass correlation coefficients ranging from 0.09 to 0.36.</p><p><strong>Conclusion: </strong>Most attendings received high ratings, while lower ratings were uncommon. Most teachers receiving lower ratings received more than one, suggesting that lower ratings may be a better discriminator of teaching effectiveness than outstanding ones. Teaching ratings had low inter-rater reliability, suggesting either low validity or that learners value different characteristics in teachers.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"996-1002"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Testicular Pain and Foreign Object in Penis: Cultural and Clinical Insights on Artificial Penile Implants.","authors":"Lauren Elizabeth Damon, Mithu Molla","doi":"10.1007/s11606-024-09344-y","DOIUrl":"10.1007/s11606-024-09344-y","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1192-1193"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Systemic, Intersectional Change: A Path Forward for Reform.","authors":"Neil Singh Bedi, Raquel Selcer, Sondra Crosby","doi":"10.1007/s11606-024-09332-2","DOIUrl":"10.1007/s11606-024-09332-2","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":"40 5","pages":"1206-1207"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Medicare Eligibility at Age 65 Among Individuals With and Without Functional Disability.","authors":"Sungchul Park, Jim P Stimpson","doi":"10.1007/s11606-024-09060-7","DOIUrl":"10.1007/s11606-024-09060-7","url":null,"abstract":"<p><strong>Background: </strong>Medicare coverage at age 65 improves access to and use of care and alleviates financial hardship for the general population. However, less is known whether the effects differ between individuals without and with functional disability.</p><p><strong>Objectives: </strong>To examine the effects of Medicare eligibility at age 65 on health insurance coverage, financial burden of care, and access to care among individuals without and with functional disability.</p><p><strong>Design: </strong>We used a regression discontinuity design, which exploits the discontinuity in eligibility for Medicare at age 65 and compares individuals just before and after age 65.</p><p><strong>Participants: </strong>Our analysis included 19,876 individuals (aged 59-71) without functional disability and 8376 individuals with functional disability from the 2014-2021 Medical Expenditure Panel Survey.</p><p><strong>Main measures: </strong>We assessed health insurance coverage, financial burden of care, and access to care.</p><p><strong>Results: </strong>Medicare eligibility led to increases in any and Medicare coverage for both groups, but those with functional disability had a decrease in Medicaid coverage by - 2.6 percentage points. Medicare eligibility resulted in lower financial burden of care for both groups, but the effects were greater among those with functional disability (- $578 vs. - $344 for out-of-pocket spending, - 3.7 vs. - 4.9 percentage points for cost-sharing, and - 2.5 vs. - 0.8 percentage points for paying medical bills over time). Although Medicare eligibility led to a decrease in delayed medical care among those without functional disability (- 2.1 percentage points), no change was observed among those with functional disability. Notably, access to care remained limited among those with functional disability after obtaining Medicare eligibility (8.6% and 3.9% for being unable to get medical care and experiencing delay in getting medical care).</p><p><strong>Conclusion: </strong>Medicare coverage can reduce financial hardship, especially for individuals with functional disability. However, there is a need to develop policies that ensure equitable access to care for those with functional disability.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1132-1140"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Cannabis Use Disorder Among Primary Care Patients with Varying Frequency of Past-Year Cannabis Use.","authors":"Gwen T Lapham, Jennifer F Bobb, Casey Luce, Malia M Oliver, Leah K Hamilton, Noorie Hyun, Kevin A Hallgren, Theresa E Matson","doi":"10.1007/s11606-024-09061-6","DOIUrl":"10.1007/s11606-024-09061-6","url":null,"abstract":"<p><strong>Background: </strong>Valid, single-item cannabis screens for the frequency of past-year use (SIS-C) can identify patients at risk for cannabis use disorder (CUD); however, the prevalence of CUD for patients who report varying frequencies of use in the clinical setting remains unexplored.</p><p><strong>Objective: </strong>Compare clinical responses about the frequency of past-year cannabis use to typical use and CUD severity reported on a confidential survey.</p><p><strong>Participants: </strong>Among adult patients in an integrated health system who completed the SIS-C as part of routine care (3/28/2019-9/12/2019; n = 108,950), 5000 were selected for a confidential survey using stratified random sampling. Among 1688 respondents (34% response rate), 1589 who reported past-year cannabis use on the SIS-C were included.</p><p><strong>Main measures: </strong>We compared patients with varying frequency of cannabis use on the SIS-C (< monthly, monthly, weekly, daily) to survey responses on the Composite International Diagnostic Interview Substance Abuse Module for CUD (any and moderate-severe CUD) and cannabis exposure measures (typical use per-week, per-day). Adjusted multinomial (categorical) and logistic regression (binary), weighted for population estimates, estimated the prevalence of outcomes across frequencies.</p><p><strong>Key results: </strong>Patients were predominantly middle-aged (mean = 43.3 years [SD = 16.9]), male (51.8%), white (78.2%), non-Hispanic (94.0%), and commercially insured (68.9%). The prevalence of any and moderate-severe CUD increased with greater frequency of past-year cannabis use reported on the SIS-C (p-values < 0.001) and ranged from 12.7% (6.3-19.2%) and 0.9% (0.0-2.7%) for < monthly to 44.6% (41.4-47.7%) and 20.3% (17.8-22.9%) for daily use, respectively. Greater frequency of use on the SIS-C in the clinical setting corresponded with greater per-week and per-day use on the confidential survey.</p><p><strong>Conclusions: </strong>Among patients who reported past-year cannabis use as part of routine screening, the prevalence of CUD and other cannabis exposure measures increased with greater frequency of cannabis use, underscoring the utility of brief cannabis screens for identifying patients at risk for CUD.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1039-1047"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rising Obesity-Associated Mortality in Men: Exploration of Gender Disparity from the Global Burden of Disease Study, 1990-2019.","authors":"Yichen Wang, Yuting Huang, Mhd Manar Al Jawish, Nader G Bakheet, Andres Acosta, Tamas Ordog, Kristin Clift, Katherine Chase, Vivek Kumbhari, Dilhana S Badurdeen","doi":"10.1007/s11606-024-09033-w","DOIUrl":"10.1007/s11606-024-09033-w","url":null,"abstract":"<p><strong>Objectives: </strong>The global rise in overweight, obesity, and related diseases is undeniable; however, the pathogenesis of obesity and obesity-associated diseases is heterogeneous, with varied complications and a discordant response to treatment. Intriguingly, men have a shorter lifespan than women, despite being half as likely to be obese. This paradox suggests a potential gender disparity in the impact of obesity on mortality, with men potentially being more vulnerable to obesity-associated health risks.</p><p><strong>Methods: </strong>This retrospective study utilized Global Burden of Diseases data from 204 countries/territories to bridge the knowledge gap in understanding gender disparities in obesity-related mortality. Outcomes were obesity-associated mortality, years of life lost, years lived with disability, and disability-adjusted life years (DALYs).</p><p><strong>Results: </strong>In 2019, the global overweight/obesity-related disease burden reached 160.2 million DALYs, with 5.02 million associated deaths. From 1990 to 2019, the age-standardized death rates increased in males (from 58.19 to 66.55 per 100,000 person-years, APC = 0.36%, 95% CI: 0.30 to 0.42%, P < 0.001), while females experienced a decrease in age-standardized death rates (from 59.31 to 58.14 per 100,000 person-years, APC = -0.22%, 95% CI: -0.29% to -0.14%, P < 0.001). Age-standardized DALYs increased more in males (1632.5 to 2070.34 per 100,000 years, APC = 0.74%, 95% CI: 0.70% to 0.78%, P < .001) compared to females (1618.26 to 1789.67 per 100,000 years, APC = 0.24%, 95% CI: 0.19% to 0.29%, P < 0.001). Disparities were more pronounced in countries with a higher socioeconomic status and predominantly affected younger populations.</p><p><strong>Conclusions: </strong>Overweight/obesity-related morbidity and mortality are higher among male sex. Identifying differences in pathogenesis, complications and treatment response is crucial to develop targeted interventions and equitable public health policies to combat this global burden.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1097-1106"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Disease Burden and Healthcare Utilization by Gender Among US Adults with Lifetime Criminal Legal Involvement.","authors":"Amelia Papadimitriou, Laura Hawks, Joni S Williams, Leonard E Egede","doi":"10.1007/s11606-025-09416-7","DOIUrl":"10.1007/s11606-025-09416-7","url":null,"abstract":"<p><strong>Background: </strong>Criminal legal involvement (CLI) has been associated with increased burden of disease, worse health outcomes, and high healthcare utilization. The health needs of women with CLI are often overlooked despite the rising proportion of women in the US legal system.</p><p><strong>Objective: </strong>Examine differences by binary gender in the prevalence of disease and healthcare utilization among individuals with lifetime CLI.</p><p><strong>Design/setting: </strong>Cross-sectional nationally representative multivariate logistic regression and negative binomial regression.</p><p><strong>Participants: </strong>Adult respondents with lifetime CLI (N = 37,279) with response rate of 66-69%.</p><p><strong>Measures: </strong>The primary independent variable was binary gender (woman/man). Outcomes included medical conditions, substance use disorders, mental illness, and healthcare utilization. Covariates included sociodemographic confounders.</p><p><strong>Results: </strong>Women comprised 29.1% of respondents with lifetime CLI and reported 0.83 times the odds of chronic heart disease compared to men (95%CI 0.74, 0.92; p = 0.001), but 1.86 times the odds of COPD (95%CI 1.63, 2.13; p < 0.001), 1.78 times the odds of asthma (95%CI 1.63, 1.93; p < 0.001), and 1.30 times the odds of cancer (95%CI 1.08, 1.53; p = 0.005). While women were less likely to have a substance use disorder (OR 0.84; 95%CI 0.78, 0.90), they were more likely to currently smoke (OR 1.29, 95%CI 1.20, 1.28; p < 0.001) and to have any mental illness (OR 2.45; 95%CI 2.26, 2.63; p < 0.001). Women reported increased rates of all forms of healthcare utilization compared to men after adjustments.</p><p><strong>Conclusions: </strong>Women with lifetime CLI experience a different profile of diseases compared to men with increased prevalence of any mental illness and chronic disease, especially respiratory diseases. They also had higher rates of healthcare utilization. Additional research should focus on interventions tailored to the unique needs of this population.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1116-1122"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Acceptability of Technology-Based Safety Planning in Primary Care.","authors":"Jordan M Braciszewski, Elyse N Llamocca, Elizabeth Lockhart, Alyssa M Vanderziel, Mia L Boulay, Brian K Ahmedani","doi":"10.1007/s11606-024-09116-8","DOIUrl":"10.1007/s11606-024-09116-8","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1217-1218"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor Response: The General Internal Medicine Physician's Role in Addressing the Maternal Health Crisis in the USA.","authors":"Natalie A Cameron, Amy Weil, Brigid M Dolan","doi":"10.1007/s11606-024-09237-0","DOIUrl":"10.1007/s11606-024-09237-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1202"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Long COVID on Employment and Well-Being: A Qualitative Study of Patient Perspectives.","authors":"Sarah R MacEwan, Saurabh Rahurkar, Willi L Tarver, Leanna Perez Eiterman, Halia Melnyk, Ramona G Olvera, Jennifer L Eramo, Lauren Teuschler, Alice A Gaughan, Laura J Rush, Stacy Stanwick, Susan Bowman Burpee, Erin McConnell, Andrew Schamess, Ann Scheck McAlearney","doi":"10.1007/s11606-024-09062-5","DOIUrl":"10.1007/s11606-024-09062-5","url":null,"abstract":"<p><strong>Background: </strong>Exploring the experiences of Long COVID patients who face challenges with employment may inform improvements in how healthcare systems can provide holistic care for this patient population.</p><p><strong>Objective: </strong>Understand perspectives about the impact of Long COVID on employment and well-being among patients seeking healthcare for Long COVID.</p><p><strong>Design: </strong>Qualitative study involving one-on-one interviews.</p><p><strong>Participants: </strong>Eligible participants were 18 years of age or older, spoke English, self-reported as doing well in daily life before having COVID-19, and reported that COVID-19 was still having a significant impact on their life three or more months following an acute infection.</p><p><strong>Approach: </strong>Participants were recruited from a post-COVID recovery clinic at an academic medical center. Interviews were conducted from August to September 2022.</p><p><strong>Key results: </strong>Among all participants (N = 21), most described that they were not able to work at a capacity equivalent to their norm pre-COVID-19. For those who continued working after their COVID-19 infection, the effort and energy required for work left little capacity to participate in other life activities and made it difficult to attend recommended healthcare appointments. Participants reported financial impacts of changes in employment including loss of income and changes in insurance, which were compounded by high healthcare costs. Changes in employment resulted in emotional repercussions including feelings of loss of self-identity and fear of judgement at work. Participants discussed issues surrounding access to strategies to address challenges posed by the impact of Long COVID on employment, including strategies learned from healthcare providers to cope with Long COVID symptoms at work and efforts to seek disability benefits or workplace accommodations.</p><p><strong>Conclusions: </strong>Patients with Long COVID may face significant challenges due to changes in their ability to work. Healthcare providers can support these patients by connecting them to financial assistance resources, facilitating appropriate mental health treatment, and expediting workplace accommodation requests.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"1070-1077"},"PeriodicalIF":4.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}