Journal of General Internal Medicine最新文献

{"title":"What's in a Name?","authors":"Nidhi N Patel","doi":"10.1007/s11606-024-09253-0","DOIUrl":"10.1007/s11606-024-09253-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"946"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801016","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":"Decoding Homelessness: Z-Codes and the Recognition of Homelessness as a Comorbid Condition.","authors":"Sansrita Nepal, Lawrence A Haber, Sarah A Stella","doi":"10.1007/s11606-024-09136-4","DOIUrl":"10.1007/s11606-024-09136-4","url":null,"abstract":"<p><p>There are an estimated 653,100 people across the United States experiencing homelessness. Homelessness is an important social determinant of health associated with increased morbidity and mortality. The prevalence of homelessness among hospitalized patients is substantially higher than the community prevalence, and people experiencing homelessness (PEH) are more likely to be admitted to the hospital and have longer length of stays and higher healthcare costs relative to stably housed patients. The Centers for Medicare and Medicaid Services (CMS) recently introduced an important policy change related to documenting, coding, and billing for homelessness within the Hospital Inpatient Prospective Payment System that all inpatient clinicians, especially those practicing and leading within safety-net systems, should understand. Here, we review the historical purpose and utilization of codes to identify SDOH (\"Z-codes\"); describe how the recent CMS policy change elevates the importance of homelessness within medical care and impacts reimbursement; analyze the potential risks and benefits of this change to patients, clinicians, and health systems; and assess barriers to implementation. We conclude by calling for health systems to move beyond simply documenting homelessness to meaningfully addressing health inequities in PEH.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"922-926"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604783","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":"Bias Sensitivity in Diagnostic Decision-Making: Comparing ChatGPT with Residents.","authors":"Henk G Schmidt, Jerome I Rotgans, Silvia Mamede","doi":"10.1007/s11606-024-09177-9","DOIUrl":"10.1007/s11606-024-09177-9","url":null,"abstract":"<p><strong>Background: </strong>Diagnostic errors, often due to biases in clinical reasoning, significantly affect patient care. While artificial intelligence chatbots like ChatGPT could help mitigate such biases, their potential susceptibility to biases is unknown.</p><p><strong>Methods: </strong>This study evaluated diagnostic accuracy of ChatGPT against the performance of 265 medical residents in five previously published experiments aimed at inducing bias. The residents worked in several major teaching hospitals in the Netherlands. The biases studied were case-intrinsic (presence of salient distracting findings in the patient history, effects of disruptive patient behaviors) and situational (prior availability of a look-alike patient). ChatGPT's accuracy in identifying the most-likely diagnosis was measured.</p><p><strong>Results: </strong>Diagnostic accuracy of residents and ChatGPT was equivalent. For clinical cases involving case-intrinsic bias, both ChatGPT and the residents exhibited a decline in diagnostic accuracy. Residents' accuracy decreased on average 12%, while the accuracy of ChatGPT 4.0 decreased 21%. Accuracy of ChatGPT 3.5 decreased 9%. These findings suggest that, like human diagnosticians, ChatGPT is sensitive to bias when the biasing information is part of the patient history. When the biasing information was extrinsic to the case in the form of the prior availability of a look-alike case, residents' accuracy decreased by 15%. By contrast, ChatGPT's performance was not affected by the biasing information. Chi-square goodness-of-fit tests corroborated these outcomes.</p><p><strong>Conclusions: </strong>It seems that, while ChatGPT is not sensitive to bias when biasing information is situational, it is sensitive to bias when the biasing information is part of the patient's disease history. Its utility in diagnostic support has potential, but caution is advised. Future research should enhance AI's bias detection and mitigation to make it truly useful for diagnostic support.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"790-795"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604767","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":"Xylazine Induced Skin Necrosis.","authors":"Escher Howard-Williams, Amy Tierney","doi":"10.1007/s11606-024-09077-y","DOIUrl":"10.1007/s11606-024-09077-y","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"941-942"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361648","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 Editor: ACP in Medicare Beneficiaries with HF.","authors":"Yonsu Kim, Jong Ho Won, Ji Won Yoo","doi":"10.1007/s11606-024-09235-2","DOIUrl":"10.1007/s11606-024-09235-2","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"950-951"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780240","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":"Proton Pump Inhibitor Use and Worsening Kidney Function: A Retrospective Cohort Study Including 122,606 Acid-Suppressing Users.","authors":"Antonio González-Pérez, Samuel J Martínez-Domínguez, Ángel Lanas, Aitor Lanas, Pablo Iñigo, Luis A García-Rodríguez","doi":"10.1007/s11606-024-09213-8","DOIUrl":"10.1007/s11606-024-09213-8","url":null,"abstract":"<p><strong>Background: </strong>The impact of proton pump inhibitors (PPIs) use on worsening renal function is controversial and lacks a solid pathophysiological explanation.</p><p><strong>Objective: </strong>To assess the risk of worsening renal function and acute kidney injury (AKI) in PPI initiators as compared with H2-blockers initiators.</p><p><strong>Design: </strong>Retrospective cohort study using longitudinal records from BIGAN, a population-based health database of Aragón (Spain).</p><p><strong>Participants: </strong>PPIs (n = 119,520) and H2-blockers (n = 3,086) initiators between 2015 and 2020 with preserved renal function. They were followed until the occurrence of an adverse kidney event, death, lost to follow-up or June 2021.</p><p><strong>Main measures: </strong>Primary endpoints were worsening kidney function (measured as sCr ≥ 2 times baseline, eGFR < 60 ml/min/1.73m², a decrease in eGFR 30-50% from baseline or end stage renal disease) and AKI (measured by Aberdeen algorithm or hospitalization due to AKI). Incidence rates (IRs) per 1,000 persons-years were reported and Cox regression was used to calculate Hazard ratios (HRs), adjusted for confounders.</p><p><strong>Key results: </strong>Crude IRs for worsening kidney function were consistently lower for ranitidine than for PPIs (eGFR < 60 ml/min/1.73m²: IR 18.7 95%CI (12.0-27.8) for ranitidine, IR 31.2 95%CI (29.9-32.5) for omeprazole). However, the risk of incident worsening function did not significantly differ in the Cox regression analysis adjusting for confounders (HR 0.99 95%CI (0.66-1.48) for omeprazole, as compared to ranitidine). PPI initiators consistently showed lower IRs of AKI using Aberdeen algorithm (IR 33.8 95%CI (32.4-35.1) for omeprazole, IR 52.8 95%CI (40.9-67.1) for ranitidine) and lower risk of AKI (HR 0.54 95%CI (0.42-0.70) for omeprazole, as compared to ranitidine).</p><p><strong>Conclusions: </strong>No clinically relevant differences were observed for worsening kidney function between PPIs and H2-blockers initiators. PPIs users presented a reduced risk of AKI compared to ranitidine initiators.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"818-827"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769662","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 Primary Care Pipeline: Let's Consider Ikigai.","authors":"Sherine Salib","doi":"10.1007/s11606-024-09241-4","DOIUrl":"10.1007/s11606-024-09241-4","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"948-949"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780250","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":"USMLE Performance, Subsequent Standardized Testing, and ABIM Certification Exam Preparation for Internal Medicine Residency Programs: A Narrative Review.","authors":"Dustin T Smith, Alexander T Matelski, Mary Ann Kirkconnell Hall, Varun K Phadke, Theresa Vettese, Karen Law, Reena Hemrajani","doi":"10.1007/s11606-024-09229-0","DOIUrl":"10.1007/s11606-024-09229-0","url":null,"abstract":"<p><p>Standardized examinations measure progress throughout medical education. Successful completion of the American Board of Internal Medicine Certification Examination (ABIM-CE) benchmarks completion of internal medicine (IM) residency training. Recent declines in initial ABIM-CE pass rates may prompt residency programs to examine strategies to improve learner performance. We synthesized published literature on associations between the United States Medical Licensing Examination (USMLE), in-training examination (ITE), and board preparation to support residents for ABIM-CE. We searched MEDLINE for test performance and preparation strategies for IM board certification during training. Relevant articles published until March 15, 2024, were screened using pre-defined criteria for narrative review, then codified into three domains (USMLE, ITE, curriculum/program strategies). Findings were grouped by theme into considerations for training programs seeking guidance on learning augmentation plans to improve resident performance on ABIM-CE. Themes drawn from articles focused on USMLE include validity in predicting CE performance, noting (1) failing USMLE Step 1 is associated with failing ABIM-CE, (2) any USMLE score < 220 increases failure probability, and (3) a mean USMLE ≥ 250 approximates ~ 100% pass rates on board examination. Inferences from ITE-focused articles support use as a predictive tool; specifically, a score < 35th percentile signals a resident at risk for failing the ABIM-CE while > 70th percentile is predictive of passing. Lastly, inferences from curriculum- and program-focused articles suggest standard contents (conferences) do not correlate with CE passage, while targeted clinical reasoning and remediation plans do. IM residency programs should consider adopting learning augmentation strategies targeted to at-risk residents to support CE passage.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"879-891"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780258","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":"Evaluation of Measure Dx, a Resource to Accelerate Diagnostic Safety Learning and Improvement.","authors":"Andrea Bradford, Alberta Tran, Kisha J Ali, Alexis Offner, Christine Goeschel, Umber Shahid, Melissa Eckroade, Hardeep Singh","doi":"10.1007/s11606-024-09132-8","DOIUrl":"10.1007/s11606-024-09132-8","url":null,"abstract":"<p><strong>Background: </strong>Several strategies have been developed to detect diagnostic errors for organizational learning and improvement. However, few health care organizations (HCOs) have integrated these strategies into routine operations. To address this gap, the Agency for Healthcare Research and Quality released \"Measure Dx: A Resource To Identify, Analyze, and Learn From Diagnostic Safety Events\" in 2022.</p><p><strong>Objective: </strong>We conducted an evaluation of Measure Dx to measure feasibility of implementation and effects on short-term and intermediate outcomes related to diagnostic safety.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Participants: </strong>Teams from 11 HCOs, primarily academic medical centers.</p><p><strong>Interventions: </strong>Participants were asked to use Measure Dx over approximately 6 months and attend monthly virtual learning collaborative sessions to share and discuss approaches to measuring diagnostic safety.</p><p><strong>Main measures: </strong>Descriptive outcomes were gathered at the HCO level and included uptake of different case-finding strategies and the number of cases reviewed and confirmed to have diagnostic safety improvement opportunities. We collected information on organizational practices related to diagnostic safety at each HCO at baseline and at the conclusion of the project.</p><p><strong>Key results: </strong>The 11 HCOs completed all requirements for the evaluation. Each of the four diagnostic safety case finding strategies outlined in Measure Dx were used by at least three HCOs. Across the cohort, participants reviewed 703 cases using a standardized data collection instrument. Of those cases, 224 (31.8%) were identified as diagnostic safety events with improvement opportunities. Unexpectedly, self-ratings on the checklist assessment declined for several organizations.</p><p><strong>Conclusions: </strong>Use of Measure Dx can help accelerate implementation of systematic approaches to diagnostic error measurement and learning across a variety of HCOs, while potentially enabling HCOs to identify opportunities to improve diagnostic safety practices.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"782-789"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501862","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":"Vaccine Messaging by the FDA: A National Randomized Survey Study.","authors":"William B Feldman, Leah Z Rand, Daniel Carpenter, Eric G Campbell, Jonathan J Darrow, Aaron S Kesselheim","doi":"10.1007/s11606-024-09059-0","DOIUrl":"10.1007/s11606-024-09059-0","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"962-966"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361647","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}