Journal of General Internal Medicine最新文献

{"title":"Should Legal Status Determine Mortality? The Experience of Undocumented Individuals Denied a Curative Stem Cell Transplant Because of Uninsurance.","authors":"Maylyn Martinez, Milda Saunders, Lenny López","doi":"10.1007/s11606-025-09603-6","DOIUrl":"https://doi.org/10.1007/s11606-025-09603-6","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110897","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 to: Exploring Patients' and Chaplains' Perspectives About a Spiritual Care Program in the Primary Care Setting.","authors":"Vignesh Sadras, Joseph A Carrese, Andrea Fitz, Macy L E Gatti, Paula Teague","doi":"10.1007/s11606-025-09624-1","DOIUrl":"https://doi.org/10.1007/s11606-025-09624-1","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110805","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":"Impostor Phenomenon in Resident Physicians: A Qualitative Thematic Analysis of a Cross-Sectional Survey.","authors":"Anuranita Gupta, Sophia Landay, Kenneth Mukamal, Cancan Zhang, Shreya P Trivedi, C Christopher Smith","doi":"10.1007/s11606-025-09616-1","DOIUrl":"https://doi.org/10.1007/s11606-025-09616-1","url":null,"abstract":"<p><strong>Background: </strong>Impostor phenomenon (IP) is defined as self-doubt among high-achieving individuals. Previous studies have shown a high prevalence of IP among resident physicians, which can negatively impact the learning environment of academic teaching hospitals.</p><p><strong>Objectives: </strong>This study explores how medical team leaders can help resident physicians overcome IP.</p><p><strong>Methods: </strong>A survey was conducted from February to June 2024 among internal medicine (IM), general surgery, and obstetrics and gynecology residents at Beth Israel Deaconess Medical Center. Using pragmatic qualitative analysis, the study identified leadership strategies that help alleviate IP.</p><p><strong>Results: </strong>Out of 125 respondents (49% response rate), 70% were IM residents, 14% OB-GYN, and 16% general surgery residents. Higher PGY levels were associated with lower odds of frequent IP, with an odds ratio of 0.71 (95% confidence interval of 0.51-0.97). Gender and specialty were not significantly associated with higher IP frequency. Effective leadership strategies included normalizing IP, providing specific feedback, demonstrating trust, and fostering a safe space to discuss negative thoughts.</p><p><strong>Conclusion: </strong>Team leaders can help with learners' IP by normalizing it, taking time to give specific and constructive feedback, empowering the learner through trust, and creating a safe space to discuss negative self-perceptions. Imposter phenomenon declines with increased experience throughout residency. Future work needs to explore how to effectively train all resident and faculty team leaders with these strategies and their impact on medical student and intern wellness, especially in high-risk specialties and training levels.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110821","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":"Mindfulness-Based Interventions for Mental Health Outcomes in Frontline Healthcare Workers During the COVID-19 Pandemic: A Randomized Controlled Trial.","authors":"Marieke Arts-de Jong, Dirk E M Geurts, Philip Spinhoven, Henricus G Ruhé, Anne E M Speckens","doi":"10.1007/s11606-025-09529-z","DOIUrl":"https://doi.org/10.1007/s11606-025-09529-z","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic significantly impacted the mental health of frontline healthcare workers (HCWs), but solid evidence on psychological interventions for HCWs remains limited.</p><p><strong>Objective: </strong>Whether an adjusted therapist-assisted Mindfulness-based Stress Reduction group intervention (adjusted MBSR) is superior to a minimal self-guided mindfulness-based intervention (self-guided MBI) in improving mental health of HCWs during the COVID-19 pandemic.</p><p><strong>Design: </strong>Randomized controlled trial.</p><p><strong>Participants: </strong>201 frontline HCWs (47 physicians, 120 nurses, 34 supporting staff); enrollment between June 2020 and September 2021.</p><p><strong>Interventions: </strong>A 4-week adjusted MBSR with eight biweekly 1.5-h sessions; or a 4-week self-guided MBI with 24 mindfulness/compassion exercises.</p><p><strong>Measures: </strong>Primary outcome was the Patient Health Questionnaire - Somatic, Anxiety and Depressive Symptom Scales (PHQ-SADS) at 6-month follow-up. Secondary outcomes included posttraumatic symptoms, insomnia, alcohol use, repetitive negative thinking, mental well-being, posttraumatic growth, mindfulness, and self-compassion at post-intervention and 3- and 6-month follow-up.</p><p><strong>Key results: </strong>At 6-month follow-up, the adjusted MBSR was not superior to the self-guided MBI (mean difference (SE) PHQ-SADS, 0.23 (1.03), P=0.82). Both interventions showed similar within-group improvement in PHQ-SADS (Cohen's d between baseline and 6-month follow-up: adjusted MBSR -0.78 (95% CI -1.07; -0.48), self-guided MBI -0.72 (95% CI -1.01; -0.43)). Secondary outcomes showed that symptom trajectories differed between groups for PHQ-SADS (intervention*time F(3, 420)=3.99, P=0.008), with greater reduction at post-intervention for adjusted MBSR, and posttraumatic growth (intervention*time F(3, 350)=5.32, P=0.001), with exclusive increase post-intervention in adjusted MBSR. Both interventions showed comparable significant within-group improvements on posttraumatic symptoms, insomnia, repetitive negative thinking, mental well-being, mindfulness, and self-compassion.</p><p><strong>Conclusions: </strong>The adjusted MSBR was not superior to the self-guided MBI; both were accompanied by significant reductions of depressive, anxiety, and somatic symptoms after 4 weeks of treatment which was sustained at 6-month follow-up. Further research is needed to investigate the possible role of MBIs to support HCWs involved in future healthcare crises.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT04720404; onderzoekmetmensen.nl/en NL73793.091.20.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094021","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 New Pain Scale.","authors":"Laura M Holzman","doi":"10.1007/s11606-025-09593-5","DOIUrl":"https://doi.org/10.1007/s11606-025-09593-5","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078329","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":"Clinical Utility of Routine Monoclonal Gammopathy Testing in the Evaluation of Peripheral Neuropathy.","authors":"Mackenzie D Maberry, Caleb J Smith, Ronald S Go","doi":"10.1007/s11606-025-09528-0","DOIUrl":"https://doi.org/10.1007/s11606-025-09528-0","url":null,"abstract":"<p><strong>Background: </strong>Peripheral neuropathy can be associated with certain monoclonal gammopathies; therefore, monoclonal protein testing is routinely performed in the evaluation of this symptom. However, limited data exist regarding the utility of monoclonal protein testing for this indication. Data suggest those receiving a new monoclonal gammopathy of undetermined significance (MGUS) diagnosis have similar rates of diagnosis-related anxiety when compared to those receiving a myeloma diagnosis (Maatouk et al., Blood Cancer J 9(2), 2019; Adami et al., Eur J Clin Invest 49(3), 2019; Rögnvaldsson et al., Blood Cancer J 11(5):1-13, 2021).</p><p><strong>Objective: </strong>To quantify the utility of monoclonal protein testing with respect to early detection of malignancy or determining etiology of peripheral neuropathy.</p><p><strong>Design/participants: </strong>We reviewed records of patients who received monoclonal protein testing for neuropathy as per ICD-10 codes at our institution during 2021 (n=1436). All those with previously diagnosed monoclonal gammopathies were excluded (n=37). Clinical utility was defined as finding a new lymphoplasmacytic neoplasm diagnosis, or if the neuropathy was ultimately attributed to the monoclonal gammopathy identified with testing.</p><p><strong>Key results: </strong>Among 1399 patients receiving monoclonal protein testing, 148 (10.6%) were diagnosed with monoclonal gammopathy, the majority (98.6%) being MGUS. As a result of monoclonal gammopathy screening, neuropathy was ultimately attributed to monoclonal gammopathy in 12 patients (0.8% total), and two patients (0.1%) were diagnosed with a lymphoplasmacytic malignancy as a result of monoclonal protein testing.</p><p><strong>Conclusions: </strong>In the evaluation of peripheral neuropathy, routine monoclonal protein testing has low clinical utility. In our study, greater than 1 in 10 patients screened were diagnosed with MGUS, while less than 1 in 100 patients were determined to have neuropathy attributable to monoclonal gammopathy. Our data suggest the test performance of monoclonal protein testing for the indication of peripheral neuropathy without other findings to suggest an underlying paraproteinemic process, such as bony pain, renal dysfunction, or unexplained anemia, is poor, and this test should be reserved for individuals in whom alternative diagnoses are first considered and excluded.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086314","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":"It's Time for Health Care to See the Humanism in Housing.","authors":"Anna L Thorndike, Keiki Hinami, Marshall H Chin","doi":"10.1007/s11606-025-09608-1","DOIUrl":"https://doi.org/10.1007/s11606-025-09608-1","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086316","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":"No Sex Difference in Resident Self-organisation on the Internal Medicine Ward: a Time-Motion Study.","authors":"Vanessa Kraege, Marie Méan, Margherita Plebani, Pedro Marques-Vidal, Antoine Garnier","doi":"10.1007/s11606-025-09597-1","DOIUrl":"https://doi.org/10.1007/s11606-025-09597-1","url":null,"abstract":"","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078298","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":"Veterans' Experiences with COVID-19 and How Providers Can Shape Care and Perception with Empathy.","authors":"Valentina V Petrova, Aaron P Turner, Carol Simons, Neelab A Kamiab, Kristina Crothers, George G Sayre","doi":"10.1007/s11606-025-09557-9","DOIUrl":"https://doi.org/10.1007/s11606-025-09557-9","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic challenged healthcare systems like the Department of Veterans Affairs (VA) to pivot to new models of care and keep up with rapidly evolving practice and treatment guidelines. These challenges were amplified by the context of a polarized society and widespread mistrust of government and traditional media communication.</p><p><strong>Objective: </strong>We sought to better understand experiences with COVID-specific care and the role of patient-provider interactions.</p><p><strong>Design: </strong>Using semi-structured qualitative phone interviews, we collected Veterans' accounts of their treatment, recovery, and any follow-up care for COVID-19.</p><p><strong>Participants: </strong>We used VA electronic health records data to recruit a nationally representative sample of participants across three disease severity categories (ICU, acute care hospitalization, and outpatient) and across three timepoints (2-8 weeks, 8 weeks to 6 months, and 12 months) after having COVID-19. A total of 94 Veterans were interviewed by phone once between June 2021 and June 2022.</p><p><strong>Approach: </strong>Interviews were transcribed and analyzed using deductive-inductive content analysis.</p><p><strong>Key results: </strong>Three main themes emerged: (1) Veterans made sense of their COVID-19 experiences by comparing themselves to others and doing their own research, often feeling they had to defend their beliefs to others and in the face of critical media coverage; (2) perceptions of care sometimes aligned with distrust in institutions but positive communication with healthcare providers substantially impacted Veterans' trust in their VA care; and (3) the most effective healthcare interactions resulted from clear and empathetic answers from trusted providers.</p><p><strong>Conclusions: </strong>Clear, consistent messages delivered with respect and empathy had the potential to overcome patients' hesitancy and mistrust of government and media information sources.</p><p><strong>Trial registration: </strong>Chronic Lung Disease and COVID-19: Understanding Severity, Recovery and Rehabilitation Needs (LAUREL), ClinicalTrials.gov ID NCT04628039.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078301","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":"Empathy Decline During Medical Training: Insights from a Novelist.","authors":"Barry R Meisenberg","doi":"10.1007/s11606-025-09567-7","DOIUrl":"https://doi.org/10.1007/s11606-025-09567-7","url":null,"abstract":"<p><p>Modern concerns that medical students and trainees suffer a loss of empathy during medical training have generated handwringing, research, and innovation. But a literary vignette from a well-known American author reveals adverse attitude changes during medical training have been noted for more than a hundred years. Loss of empathy and rise of cynicism among students has been a subject of academic scrutiny for many decades though the focus has shifted from deficiencies of the student to deficiencies of the care delivery system in which they learn. The causes of empathy loss were recognized in the vignette and are little changed: exhaustion due to the stress and burden of working with the acutely ill in high volume, a devaluing of patient suffering due to insecurity about one's own clinical competence, and working within health care systems that do not celebrate empathy or its sister virtue compassion, as useful or desirable skills on the road to clinical competence. But data is available that links empathetic relationships with many types of improved clinical outcomes. Evidence-based tools for relationship building are available for adaptation in the student/trainee situation. Educators should emphasize the link between empathy and improved clinical outcomes in designing empathy-sustaining curricula.</p>","PeriodicalId":15860,"journal":{"name":"Journal of General Internal Medicine","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078287","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}