Journal of General Internal Medicine最新文献

{"title":"Perceived Connections Between Personal Values and Health in High-Risk Patients with Multimorbidity: A Qualitative Study.","authors":"Linnaea Schuttner, Jonathan Staloff, Mariah Theis, James D Ralston, Ann-Marie Rosland, Karin Nelson, Laura Coyle, Scott Hagan, Tamara Schult, Traci Solt, Katherine Ritchey, George Sayre","doi":"10.1007/s11606-025-09448-z","DOIUrl":"https://doi.org/10.1007/s11606-025-09448-z","url":null,"abstract":"<p><strong>Background: </strong>Aligned with increasing organizational and policy focus on whole person care, particularly for patients with multimorbidity, health systems are operationalizing how to assess what patients find meaningful in life for personalized health planning. Few studies have examined how patients with multimorbidity at high risk of adverse events perceive connections between what is most important in life (i.e., personal values) and health, healthcare, and healthcare decisions. This knowledge is critical to optimizing how, when, and under what circumstances the topics are addressed in healthcare settings.</p><p><strong>Objective: </strong>To understand how high-risk patients with multimorbidity perceive connections between personal values and health, healthcare, and healthcare decisions.</p><p><strong>Design: </strong>Qualitative study.</p><p><strong>Participants: </strong>Patients ≥ 75th percentile risk of hospitalization or mortality using a validated prediction score, with ≥ 2 diagnoses among depression, hypertension, chronic kidney disease, or diabetes, engaged in Veterans Health Administration primary care.</p><p><strong>Approach: </strong>Individual semi-structured telephone interview, analyzed with content analysis.</p><p><strong>Key results: </strong>Patients (N=27) averaged 68 years old; 17 (63%) were male. Three main themes emerged: (1) personal values were rarely discussed in healthcare settings or reflected in healthcare decision-making, sometimes given perceived lower relevance by patients; (2) when personal values were perceived as affecting health decisions, it was within specific contexts or circumstances (e.g., deciding on surgery); (3) eliciting personal values in healthcare settings could have positive or negative consequences, related to conditions of disclosure and resultant action taken in the care plan, and not all patients wanted to disclose values.</p><p><strong>Conclusions: </strong>In this study, high-risk patients with multimorbidity reported rarely discussing values in healthcare settings, and if so, only perceived relevant connections between values and health in specific contexts. While some participants felt sharing values benefitted care, not all felt comfortable with disclosure. Patient preferences for eliciting and incorporating values are relevant to integrating patient personal values in healthcare settings.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556999","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 Cross-Sectional Study of Online Survey Respondents' Knowledge and Attitudes Toward Delirium.","authors":"Ryan Townshend, Eduard E Vasilevskis, Fauzia Hollnagel, Blair P Golden","doi":"10.1007/s11606-025-09445-2","DOIUrl":"https://doi.org/10.1007/s11606-025-09445-2","url":null,"abstract":"<p><strong>Background: </strong>Delirium affects approximately a quarter of hospitalized adults and is associated with higher mortality, cognitive decline, and prolonged hospitalizations. Patient and caregiver education may improve outcomes. However, limited literature exists on the general public's current understanding of this condition.</p><p><strong>Objective: </strong>To assess knowledge and attitudes toward delirium via an online convenience sample.</p><p><strong>Design: </strong>Cross-sectional survey using Amazon's Mechanical Turk between October 2023 and January 2024.</p><p><strong>Participants: </strong>Adults 18 years old and older, living in the USA, and fluent in English.</p><p><strong>Main measures: </strong>We assessed delirium knowledge using a 15-question knowledge assessment covering three categories (risk factors, symptoms, and management). We compared mean scores between knowledge categories using one-way analysis of variance (ANOVA). We used univariate and multivariate logistic regression models to identify demographics associated with low delirium knowledge scores.</p><p><strong>Key results: </strong>Among 397 respondents, 52% were male, 67% were White, and the median age was 44.6 (IQR 36-52). Participants reported living in 43 states. Participants answered 59% (SD 14.8) of knowledge questions correctly; respondents performed highest within the risk factor category (74%, SD 19.6) and lowest in management (47%, SD 21.1), p = <0.01. Few knew that bedrest is not recommended for delirium and that symptoms do not develop gradually (18% and 25%, respectively). Most (83%) agreed that more patient and caregiver education on delirium is needed. In multivariate analysis, individuals with higher incomes were less likely to score in the lowest quartile compared to those earning under $50K (e.g., OR 0.60 for persons earning $50-100K, 95% CI 0.29-0.91). Finally, low self-confidence in delirium knowledge was not associated with low knowledge scores.</p><p><strong>Conclusions: </strong>Respondents had misconceptions about delirium that could be addressed in future educational initiatives, including the importance of early mobilization. Further work is needed to characterize what types of knowledge are valued by patients and caregivers and are critical to facilitating engagement.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542183","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":"Associations Between Suboptimal Social Determinants of Health and Diabetes Distress in Low-Income Patients on Medicaid.","authors":"Emily H Williams, Lucia D Juarez, Caroline A Presley, April Agne, Andrea L Cherrington, Carrie R Howell","doi":"10.1007/s11606-025-09367-z","DOIUrl":"10.1007/s11606-025-09367-z","url":null,"abstract":"<p><strong>Aims: </strong>To determine associations between suboptimal social determinants of health (SDoH) and diabetes distress in adults with diabetes on Medicaid.</p><p><strong>Methods: </strong>We surveyed adults with type 2 diabetes covered by Alabama Medicaid. Diabetes distress was assessed using the Diabetes Distress Scale. Suboptimal SDoH included food or housing insecurity; having < high school degree; being unemployed; and household income < $10,000/year. Unadjusted associations between individual SDoH and diabetes distress were examined using logistic regression. We also examined the association between the number of suboptimal SDoH and distress. Multivariable models controlled for age, sex, race, marital status, rurality, diabetes duration, social support, and insulin use.</p><p><strong>Results: </strong>In total, 433 patients participated (mean age, 50 years (SD 10.4); 80% female; 62% Black). Roughly 32% reported food insecurity, participants experienced a mean of 2 (SD, 0.9; range 0-5) suboptimal SDoH. There was increased odds of diabetes distress in participants who reported food insecurity (OR, 2.2; 95% CI, 1.36-3.65 and OR, 2.35; 95% CI, 1.40-3.93). For each additional suboptimal SDoH a patient experienced, they had increased odds of experiencing diabetes distress (OR, 1.50; CI, 1.15-2.01).</p><p><strong>Conclusions: </strong>Participants with diabetes who reported food insecurity or experienced a higher number of suboptimal social determinants of health had an increased likelihood of experiencing diabetes distress.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542186","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":"How Medical Students Across the USA Use Generative Artificial Intelligence for Learning: A Cross-Sectional Survey.","authors":"Shirin Salehi, Jessica Bethlahmy, Devan Peterson, Erin Newman, Emilie Chow","doi":"10.1007/s11606-025-09427-4","DOIUrl":"https://doi.org/10.1007/s11606-025-09427-4","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542220","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 Future Physician-Scientists in Social Sciences and Humanities.","authors":"David T Zhu","doi":"10.1007/s11606-025-09452-3","DOIUrl":"https://doi.org/10.1007/s11606-025-09452-3","url":null,"abstract":"<p><p>MD/PhD programs have traditionally prioritized the biomedical sciences, training physician-scientists skilled at advancing medical knowledge. Yet, with health disparities increasingly traced to social determinants of health (SDOH), a broader approach-one that integrates \"non-traditional\" fields such as the social sciences and humanities (SSH)-is essential. Significant challenges persist at three levels: (1) at the structural and systemic levels, where funding mechanisms like the NIH's Medical Scientist Training Program (MSTP) prioritize biomedical fields, limiting support for SSH fields; (2) at the institutional level, where curricula and resources remain narrowly aligned with biomedical timelines, leaving SSH trainees without adequate support; and (3) at the individual level, where the demands of SSH research often clash with the broader structure of MD/PhD programs, creating unique hurdles. Addressing these barriers requires coordinated reforms, including expanding MSTP programs' eligibility to include SSH fields and partnering with funding agencies and foundations to establish dedicated SSH funding. Medical schools could further support these students by developing cross-departmental SSH-integrated tracks with dedicated mentorship from SSH departments. Additionally, SSH-specific mentorship and community-building initiatives could reduce isolation and nurture a shared identity among SSH trainees. Bridging these gaps is paramount to making MD/PhD training for SSH students more inclusive and effective.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542221","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":"Expanding Access to Continuous Glucose Monitoring Through Empowering Primary Care: A Joint Endocrinology-Primary Care Quality Improvement Project.","authors":"Kristen L Flint, Madeline Fiore, Angela Justice, Jarra Carney, Caitlin A Colling, Josephine H Li, Melissa S Putman","doi":"10.1007/s11606-025-09449-y","DOIUrl":"10.1007/s11606-025-09449-y","url":null,"abstract":"<p><strong>Background: </strong>Despite guideline recommendations to offer continuous glucose monitoring (CGM) to all patients with diabetes using insulin, prescription rates for CGM remain low in primary care.</p><p><strong>Objective: </strong>This quality improvement project aimed to improve access to CGM in primary care for patients with type 2 diabetes on insulin.</p><p><strong>Design: </strong>This was a quality improvement project conducted by a joint endocrinology/primary care team at a single primary care community health clinic. After defining the problem through process mapping, driver diagrams, and Pareto charts, several interventions were trialed through Plan-Do-Study-Act (PDSA) cycles.</p><p><strong>Participants: </strong>The study team consisted of four endocrinologists, two primary care providers (MD/NP), the lead primary care nurse, and the primary care population health specialist.</p><p><strong>Interventions: </strong>Interventions included a directory for durable medical equipment (DME) suppliers, nursing education with device company representatives, a new electronic ordering system for DME, and a nursing outreach program to patients eligible for CGM.</p><p><strong>Main measures: </strong>The primary outcome was percentage of eligible patients using CGM. Process measures included the number of CGM orders started weekly. Nursing comfort with CGM, knowledge of CGM, and perceptions of communication with DME suppliers were also measured.</p><p><strong>Key results: </strong>The percentage of eligible patients using CGM increased from 28 to 42%, and the percentage of patients using CGM started in primary care increased from 8 to 14%. Weekly orders increased from 0.3 per week to 2.3 per week. Nursing reported feeling more comfortable and knowledgeable about CGM after the interventions and reported improved communication with DME suppliers.</p><p><strong>Conclusions: </strong>CGM is known to improve outcomes for patients with diabetes but is an underutilized tool in primary care. Collaborative quality improvement projects between endocrinology and primary care can rapidly build capacity within primary care to prescribe CGM and expand access for patients with diabetes who do not have endocrinologists.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542201","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":"Correction: Private Equity's Growing Presence in Hospice Care: Clinical, Research, and Policy Considerations.","authors":"Cynthia C McMahan, Lindsay M Sabik, Yael Schenker","doi":"10.1007/s11606-025-09461-2","DOIUrl":"10.1007/s11606-025-09461-2","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542189","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":"EBM BLS: Ticagrelor without aspirin one month after percutaneous coronary intervention reduces bleeding without worse cardiovascular outcomes.","authors":"Eric Nolan, Jessica Ammon, John M Cunningham","doi":"10.1007/s11606-024-09313-5","DOIUrl":"https://doi.org/10.1007/s11606-024-09313-5","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542194","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":"Association Between GLP-1 Receptor Agonists and Incidence of Lung Cancer in Treatment-Naïve Type 2 Diabetes.","authors":"Junmin Song, Ayse Ece Cali Daylan, Kuan-Yu Chi, Dharshana Prem Anand, Yu Chang, Cho-Han Chiang, Haiying Cheng","doi":"10.1007/s11606-024-09076-z","DOIUrl":"10.1007/s11606-024-09076-z","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"973-976"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372042","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":"What I Did Not Learn Within the Hospital.","authors":"Anna H Gallion, Michelle Izmaylov","doi":"10.1007/s11606-024-09122-w","DOIUrl":"10.1007/s11606-024-09122-w","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":"943-944"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467352","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}