Journal of General Internal Medicine最新文献

{"title":"RE: Putting the PASC Score to the Test: Clinical vs. Statistical Accuracy in Long COVID Diagnosis (Azola et al. JGIM).","authors":"Jason D Goldman, Jeffrey N Martin","doi":"10.1007/s11606-026-10852-2","DOIUrl":"https://doi.org/10.1007/s11606-026-10852-2","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182325","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":"Self-Reported Obesity Medicine Competence, Knowledge, and Attitudes Among US Medical Students: An Eight-School Pre- vs. Post-Intervention Study.","authors":"Magdalena Pasarica, Robert F Kushner, Angelina V Leary, Amber Mirando, Ricardo Correa, Monica Agarwal, Eduardo Grunvald, Sadie Trammell Velasquez, Virginia Uhley, Jonathan Q Purnell, Dee-Ann Carpenter, Amanda Velazquez, Gabriel Smolarz, Colleen Croniger, Mark S Johnson, Julie Loza, Andrew Mock, Kim Pfotenhauer","doi":"10.1007/s11606-026-10913-6","DOIUrl":"https://doi.org/10.1007/s11606-026-10913-6","url":null,"abstract":"<p><strong>Background: </strong>Obesity contributes to many chronic diseases that internists manage. Even though there is a documented gap in obesity education, no studies have evaluated competency-based obesity education interventions from the learner perspective.</p><p><strong>Aim: </strong>To develop and implement a pilot, multi-institutional, competency-based obesity medicine curriculum intervention, with the learner perspective as the primary outcome.</p><p><strong>Program description: </strong>We developed and implemented an educational intervention grounded in social constructivist learning theory and guided by the logic model framework. Students provided self-rating on each of the 32 obesity medicine competencies and their beliefs, attitudes, and knowledge of obesity medicine, both pre- and post-interventions.</p><p><strong>Setting and participants: </strong>Eight diverse US medical schools participated (September 2023-October 2025); pre- and post-intervention surveys were completed by 1829 (60%) and 1187 (39%) students, respectively. The dialogue within school-based teams was supported by an expert steering committee that provided scaffolding and expertise.</p><p><strong>Program evaluation: </strong>Following the intervention, students reported significantly (p < 0.001) higher ratings across all 32 obesity medicine competencies (3.15 ± 0.56 vs. 2.79 ± 0.72; mean ± SD), higher knowledge about obesity (3.00 ± 0.29 vs. 2.92 ± 0.29; mean ± SD), lower negative beliefs (2.08 ± 0.41 vs. 2.82 ± 0.44; mean ± SD), and higher positive attitudes toward patients with obesity (3.55 ± 0.40 vs. 1.53 ± 0.41; mean ± SD).</p><p><strong>Discussion: </strong>This large study approach demonstrates feasibility and scalability of a multi-institutional collaborative framework for addressing the curricular gap in obesity medicine education.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182436","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":"\"Most of what I do is a workaround now\": Clinician Use of Workarounds Following an EHR Transition.","authors":"Sarah C Keithly, Christine Sulc, Ekaterina Cole, Ryan Sterling, Yung-Ling Lin, Emmi Obara, Sarah Shirley, Edwin S Wong, Seppo T Rinne, Jessica Young","doi":"10.1007/s11606-026-10840-6","DOIUrl":"https://doi.org/10.1007/s11606-026-10840-6","url":null,"abstract":"<p><strong>Background: </strong>The Department of Veterans Affairs (VA) is transitioning from a homegrown electronic health record (EHR) system to a single-vendor Federal EHR system, the largest EHR transition in history. Research shows that this transition was profoundly disruptive to care during the early implementation phase, yet limited data exist on clinician experience with and response to the transition in the years following implementation of the new system.</p><p><strong>Objective: </strong>To investigate the use and perceptions of workarounds among VA clinicians using the new Federal EHR system.</p><p><strong>Design: </strong>A descriptive exploratory qualitative study.</p><p><strong>Participants: </strong>Using a mix of purposive and snowball sampling, we recruited direct care clinicians across a range of professions currently employed at the first five VA medical sites to transition to the new Federal EHR. Of the 104 clinicians invited, 30 (28.8%) participated in interviews.</p><p><strong>Approach: </strong>We conducted semi-structured interviews with clinicians approximately 1.5 to 4 years post-go-live across sites. We performed a hybrid inductive-deductive content analysis using an approach that combined templated summaries with matrix analysis. KEY RESULTS: Workarounds emerged as highly salient to clinician experience with the new EHR. Analyses generated four themes relevant to EHR workarounds: (1) ongoing EHR-related challenges impeded clinicians' job performance; (2) workarounds emerged in response to continued EHR challenges; (3) workarounds were perceived as necessary but risky to patients, users, and the health care system; and (4) as EHR problems persisted, workarounds became routine.</p><p><strong>Conclusions: </strong>Many of VA's EHR transition challenges have persisted beyond the initial implementation phase, contributing to a reliance on workarounds to overcome obstacles to care delivery. Workarounds were perceived as both beneficial and risky to users, patients, and the healthcare system. These findings highlight the importance of evaluating the role and impact of workarounds during EHR-to-EHR transitions to inform system improvements and workflow optimization.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182297","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":"Self-Adjusting Long-Term Medications: A Qualitative Descriptive Study of Patients' Practices.","authors":"Beatriz Santos, Sylvie Arnoux, Antoinette Pechère-Bertschi, Sebastien Empeyta, Patricia Hudelson, Marie Schneider","doi":"10.1007/s11606-026-10842-4","DOIUrl":"https://doi.org/10.1007/s11606-026-10842-4","url":null,"abstract":"<p><strong>Background: </strong>In response to challenges related to medication management, patients may modify their long-term medication regimens by adjusting doses, changing intake frequency, or temporarily interrupting treatment, often without consulting healthcare providers. While literature on non-adherence is extensive, research on the specific mechanisms and motivations behind medication self-adjustment remains limited.</p><p><strong>Objective: </strong>This study explored how and why patients adjust their medication without prior consultation with healthcare providers.</p><p><strong>Methods: </strong>In 2022, we conducted semi-structured interviews with 30 ambulatory patients with chronic diseases who had self-adjusted their medications without consulting a healthcare provider. The qualitative analysis used a low-inference approach to provide an in-depth description of patients' experiences. We used MAXQDA 24.6.0.</p><p><strong>Key results: </strong>Participants reported various self-adjustment techniques, including skipping doses and temporarily interrupting treatment. Adjustments were guided by physical sensations or intuitions, using the body as a compass. Personal experience could take precedence over medical recommendations, and self-adjustments were seen as a necessary process of experimentation, allowing individuals to better understand the effect the medication had on their bodies. This process was accompanied by ambivalent emotions such as freedom and empowerment, as well as guilt. Participants also established personal hierarchies regarding the importance of medications, shaped by the length of time since treatment was introduced, perceived consequences of discontinuation, and the clinical context in which the prescription was initiated.</p><p><strong>Conclusion: </strong>Adaptation of long-term prescriptions without input from healthcare professionals may pose risks to patients. These findings highlight that patients need guidance to adjust their treatment in a safer and more informed way. Strengthening patient education and fostering open dialogue are needed to help align medical decisions with individual expectations and increase trust. Future research should evaluate the implementation of collaborative care frameworks to guide practices towards a more patient-centered approach to ensure safe and effective medication management.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182363","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":"Drowning in Data, Starved for Insight: The Tragic Irony of Post-Hospital Syndrome Prevention.","authors":"Maylyn Martinez, S Ryan Greysen","doi":"10.1007/s11606-026-10911-8","DOIUrl":"https://doi.org/10.1007/s11606-026-10911-8","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182330","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":"Measuring What Matters in Primary Care: Continuity, Trust, and Stewardship.","authors":"Mark D Schwartz","doi":"10.1007/s11606-026-10936-z","DOIUrl":"https://doi.org/10.1007/s11606-026-10936-z","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182350","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":"Closing the Interpretive Gap in Urine Drug Testing: A Call for Education and Assay Modernization.","authors":"Dustin P Kee, John J Buyske, Ashish P Thakrar","doi":"10.1007/s11606-026-10919-0","DOIUrl":"https://doi.org/10.1007/s11606-026-10919-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182293","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":"Using Digital Outreach to Identify Individuals Eligible for Lung Cancer Screening: A Secondary Analysis of a Randomized Trial.","authors":"Richa Bundy, Anna C Snavely, David P Miller, Daniel S Reuland, Renée M Ferrari, Christina Bellinger, Aliza Randazzo, Lindsay Stradtman, Elena Wright, Alison T Brenner, Ajay Dharod","doi":"10.1007/s11606-026-10895-5","DOIUrl":"https://doi.org/10.1007/s11606-026-10895-5","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer is the third most common cancer in the United States, but screening rates among high-risk adults remain low. In a multisite randomized trial conducted in two large academic health systems in North Carolina, we found that a digital health intervention delivered to patients at home increased lung screening (LCS) rates. While LCS reduces mortality, identifying and reaching eligible patients is challenging and limits screening uptake.</p><p><strong>Objective: </strong>This study examines the reach of a digital health outreach strategy for determining eligibility for LCS.</p><p><strong>Design: </strong>A secondary analysis of a pragmatic randomized trial.</p><p><strong>Participants: </strong>Individuals aged 50 to 77 with a history of cigarette smoking received an invitation to use the digital health program at two academic health systems in North Carolina.</p><p><strong>Main measures: </strong>Reach of the engagement strategy overall and within demographic subgroups. Reach is defined by the proportion of patients completing LCS eligibility questions within 16 weeks of portal or text invitation.</p><p><strong>Key results: </strong>Of 26,909 individuals invited, 3,049 (11%) completed LCS eligibility questions within 16 weeks of invitation. Reach was higher among females, those aged 50-64, individuals with high/medium socioeconomic status, those with commercial insurance, and urban residents. White participants had higher reach compared to Black and Hispanic participants (12.8% vs 8.6% and 8.0%). Within 16 weeks of invitation, portal messages were read by 65.5% of recipients, with 17.1% visiting the mPATH-Lung landing page. Sending text invitations to those not reachable by portal expanded reach by 604 participants (from 2,445 to 3,409), compared to portal invitations alone.</p><p><strong>Conclusions: </strong>This scalable outreach strategy engaged a large population for lung cancer screening. However, reach was found to be lower in historically underrepresented groups. Future strategies should continue leveraging multiple communication channels, including a cellphone text primary strategy, to maximize engagement and potentially improve equitable access to healthcare services.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov NCT04083859, registered September 10, 2019. Available at: https://www.</p><p><strong>Clinicaltrials: </strong>gov/study/NCT04083859.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182512","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":"Supporting Patients with Autism Spectrum Disorder and Neurodivergence in Serious Illness Decision-Making.","authors":"Ryanne Lehenaff, Ronnye C Rutledge, Priscilla Kim, Emily Pinto Taylor","doi":"10.1007/s11606-026-10915-4","DOIUrl":"https://doi.org/10.1007/s11606-026-10915-4","url":null,"abstract":"<p><p>Neurodivergence and developmental disorders can influence how a patient interacts with their health, medical team, and the healthcare system overall. We present the case of a man with autism spectrum disorder (ASD) who was referred to palliative care clinic for assistance in determining his decision-making capacity to defer treatment for his progressive prostate cancer. Though many validated tools exist to assist providers in discussions of serious illness, none is validated in populations with neurodivergence, who have specific needs and challenges. As this population of adults living with ASD ages, it will be essential to support their decision-making surrounding diagnostic tests and medical treatments. Through this case, we highlight key components to engage patients with neurodivergence in health-related decisions. These strategies include using visual aids, avoiding abstractions, maintaining a low-stimulation sensory environment, and involving key stakeholders (e.g., family members and/or caregivers) to support decision-making. We also highlight the complex impact of multiple comorbid neuropsychiatric conditions on healthcare decision-making, and the resultant need for careful thought and innovative communication strategies this necessitates.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148384","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":"Long COVID in Primary Care: A Practical Approach to Evaluation and Management.","authors":"Anita Chopra, Hector F Bonilla, Abby L Cheng","doi":"10.1007/s11606-026-10901-w","DOIUrl":"10.1007/s11606-026-10901-w","url":null,"abstract":"<p><p>Long COVID is a multi-system, heterogeneous condition that manifests as new or worsened symptoms lasting at least 3 months following acute SARS-CoV-2 infection, often despite normal results on routine diagnostic testing. Common manifestations include fatigue, post-exertional malaise, cognitive impairment, and orthostatic intolerance. Primary care clinicians are uniquely positioned to identify and manage Long COVID due to their longitudinal relationships with patients and holistic understanding of their patients' health. However, diagnostic uncertainty, time constraints, and limited access to specialty care present significant challenges, and sometimes hesitation, to addressing Long COVID in the primary care setting. This focused narrative review provides a pragmatic, primary care-focused approach for the evaluation and management of Long COVID. Using patient-centered vignettes, we first describe common clinical presentations. Next, we provide a framework for the pathophysiological mechanisms suspected to contribute to persistent symptoms after SARS-CoV-2 infection. We then present a simple approach to Long COVID diagnosis and management that leverages primary care clinicians' skillset and highlights unique aspects of Long COVID care (e.g., diagnostic workup to evaluate for competing or coexisting diagnoses; management strategies focused on validation and supportive care, including activity pacing, multidisciplinary rehabilitation, and consideration of symptom-based medication trials). We offer practical strategies to effectively, yet efficiently, address a possible Long COVID diagnosis within the context of brief primary care visits (e.g., prioritize the most bothersome or addressable symptom(s) first, focus on one or two symptoms each visit, leverage longitudinal follow-up). We conclude with evidence-based strategies for prevention counseling, including infection prevention and early outpatient treatment during acute infection. While we remain optimistic that reliable diagnostic biomarkers and curative treatments will one day be available, until then, this primer supports primary care clinicians in recognizing Long COVID and supporting their patients who are living with it, despite the constraints of our current healthcare environment.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148140","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}