Journal of General Internal Medicine最新文献

{"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}

{"title":"Enhancing the Impact of Substance Use Navigators: Exploring Dose-Response Relationships and Socioeconomic Factors.","authors":"Jie Luo, Yang Song","doi":"10.1007/s11606-026-10813-9","DOIUrl":"https://doi.org/10.1007/s11606-026-10813-9","url":null,"abstract":"","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":"149147607","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":"RESIST: Addressing Resident Resiliency in Low-Resource Settings.","authors":"Sayed K Ali, Ali K Chandani, Falak Sayed, Zohray Talib","doi":"10.1007/s11606-026-10896-4","DOIUrl":"https://doi.org/10.1007/s11606-026-10896-4","url":null,"abstract":"<p><p>Burnout among healthcare workers in low- and middle-income countries (LMICs) is highly prevalent and driven by systemic challenges including workforce shortages, high patient volumes, and limited institutional support. These factors negatively impact trainee well-being and may compromise patient care. Despite increasing recognition of resilience as a critical competency, there is limited guidance on feasible and sustainable interventions in resource-constrained settings. We developed and implemented the RESIST strategy, a structured, low-cost approach to integrating resiliency training within residency programs at Aga Khan University Hospital, Nairobi, an ACGME-I accredited institution. The strategy targets individual, programmatic, and institutional factors through interventions focused on workload and rest optimization, emotional and peer support, skills-based training, psychological safety, and faculty engagement. Key components included duty hour monitoring, locum staffing to reduce workload, peer support groups, resiliency workshops, anonymous reporting systems, and faculty development initiatives. Implementation leveraged existing resources and emphasized contextual adaptation. Ongoing monitoring using duty hours, burnout indicators, and resident feedback informed iterative improvements. The RESIST strategy demonstrates that scalable, contextually grounded interventions can strengthen trainee well-being and support workforce sustainability in LMIC training environments.</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":"149148008","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 Cave.","authors":"Atsuko Yamahiro","doi":"10.1007/s11606-026-10905-6","DOIUrl":"https://doi.org/10.1007/s11606-026-10905-6","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136991","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":"Visible and Invisible Wounds.","authors":"Ben Sommers","doi":"10.1007/s11606-026-10912-7","DOIUrl":"https://doi.org/10.1007/s11606-026-10912-7","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137019","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}