American journal of medicine open最新文献

{"title":"GLP-1 Receptor Agonists Initiation and Risk of Acute Pancreatitis and Pancreatic Cancer: A Real-World Comparative Study","authors":"Omar Faour MD ,&nbsp;Moheb Boktor MD ,&nbsp;Hanford Yau MD ,&nbsp;Mustafa Kinaan MD ,&nbsp;Ishak A Mansi MD","doi":"10.1016/j.ajmo.2025.100114","DOIUrl":"10.1016/j.ajmo.2025.100114","url":null,"abstract":"<div><h3>Background</h3><div>Glucagon-like peptide 1 receptor agonist (GLP-1RA) medications are widely used in managing type 2 diabetes because of their cardio-renal-metabolic benefits. However, concerns persist regarding their potential association with acute pancreatitis (AP) and pancreatic cancer. This study’s objective was to examine the association of GLP-1RAs with the risk of AP and pancreatic cancer.</div></div><div><h3>Methods</h3><div>This retrospective propensity score-matched cohort study used Veterans Health Administration national data during fiscal years 2006 to 2021. Using a new-user active comparator design, we included veterans who initiated either GLP-1RA or dipeptidyl peptidase-4 inhibitor (DPP-4i) medication, the latter as an active comparator. The primary outcomes were incident AP and pancreatic cancer. We excluded patients with a history of pancreatitis, pancreatic tumors, pancreatic congenital anomalies, and alcohol use. Secondary analysis included adjusting for confounders that may have been introduced during the follow-up period, such as gallbladder diseases, and <em>post hoc</em> analysis restricted analysis to people who had normal serum lipase during follow-up.</div></div><div><h3>Results</h3><div>We matched 88,972 pairs of GLP-1RA and DPP-4i users on all characteristics. AP was diagnosed in 214 (0.24%) DPP-4i users versus 273 (0.31%) GLP-1RA users (OR 1.28; 95% CI, 1.07-1.53), and pancreatic cancer was diagnosed in 154 (0.17%) DPP-4i users versus 211 (0.24%) GLP-1RA users (OR 1.37; 95% CI, 1.11-1.69). Secondary and <em>post hoc</em> analyses showed results consistent with the primary analysis.</div></div><div><h3>Conclusions</h3><div>GLP-1RAs are associated with a modest but statistically significant increase in the risk of AP and pancreatic cancer compared to DPP-4i.</div></div><div><h3>Clinical significance</h3><div>GLP-1RA use is associated with modestly increased odds ratio of acute pancreatitis and pancreatic cancer. Whereas the increased risk seems modest compared to their benefits as shown in the literature, vigilance is recommended, specifically, when GLP-1RAs are used for off label indications.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100114"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145046095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caring for Hospitalized Patients with Substance Use Disorders: An Interprofessional Needs Assessment Survey","authors":"M. Holliday Davis ,&nbsp;Judy Chertok ,&nbsp;Shoshana Aronowitz ,&nbsp;Rachel French ,&nbsp;Jeanmarie Perrone ,&nbsp;Ashish P Thakrar ,&nbsp;Samantha Huo ,&nbsp;Jacqueline Deanna Wilson ,&nbsp;Nia Bhadra-Heintz ,&nbsp;Lilah Lesniak ,&nbsp;Aidan Hecker ,&nbsp;Jessica Tolbert ,&nbsp;Margaret Lowenstein","doi":"10.1016/j.ajmo.2025.100116","DOIUrl":"10.1016/j.ajmo.2025.100116","url":null,"abstract":"<div><h3>Background</h3><div>Hospitalizations among people who use drugs (PWUD) are increasing, and addiction consult services (ACS) are an emerging best practice for improving care.</div></div><div><h3>Methods</h3><div>We conducted a web-based needs assessment survey of physicians, advanced practice providers (APP), and nurses at a Philadelphia academic hospital in March 2023 before implementing an ACS. We assessed knowledge gaps, barriers to care, and perceived service needs.</div></div><div><h3>Results</h3><div>Of 472 clinicians surveyed, 236 responded (50% response rate). Participants felt most prepared to assess withdrawal and diagnose or recognize substance use disorders (SUDs) but lacked confidence in care linkage and harm reduction. Reported barriers included patient social needs, resource availability, and lack of expert consultation.</div></div><div><h3>Conclusions</h3><div>While most participants agreed that SUDs are treatable, many reported compromised patient care due to inadequate support as well as burnout associated with caring for PWUD. Future work should examine whether ACSs address the perceived barriers to care for hospitalized PWUD while supporting clinicians.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100116"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Different Antidiabetic Drugs on Fracture Risk in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials With a Focus on SGLT2 Inhibitors","authors":"Bushra Admani MBBS ,&nbsp;Fizza Zehra Raza MBBS ,&nbsp;Fatima Siddiqui MBBS ,&nbsp;Muhammad Talal Ashraf MBBS ,&nbsp;Muhammad Khuzzaim Khan MBBS ,&nbsp;Ifra Habib MBBS ,&nbsp;Ayesha Usman MBBS ,&nbsp;Bareeha Mansoor MBBS ,&nbsp;Zaira Nadeem MBBS ,&nbsp;Rana Jahanzeb Ghaffer MBBS ,&nbsp;Muhammad Riyyan MBBS ,&nbsp;Sawaira Sajid MBBS ,&nbsp;Muhammad Hassan Ali Chania MBBS ,&nbsp;Mahnoor Saleem MBBS ,&nbsp;Saad Javaid MBBS ,&nbsp;Nikhil Duseja MBBS ,&nbsp;Hussam Al Hennawi MD ,&nbsp;Sunita Lakhani MD","doi":"10.1016/j.ajmo.2025.100115","DOIUrl":"10.1016/j.ajmo.2025.100115","url":null,"abstract":"<div><div>SGLT2 inhibitors are a new class of antidiabetic drugs that have shown cardiovascular benefits in patients with type 2 diabetes mellitus (T2DM) and cardiovascular disease. However, their effects on fracture risk are unclear and may depend on the type and duration of treatment. This meta-analysis compares the fracture risk of different antidiabetic drugs, including SGLT2 inhibitors, based on data from randomized controlled trials (RCTs). We searched 4 databases for RCTs that reported fracture events in patients with T2DM who received different antidiabetic drugs. We included 117 RCTs that compared 9 types of antidiabetic drugs: SGLT2 inhibitors, DPP-4 inhibitors, α-glucosidase inhibitors, thiazolidinediones, insulin, GLP-1 receptor agonists, meglitinides, biguanides, and sulfonylureas. We used a statistical method called Frequentist meta-analysis to combine data from different studies and compare different treatments. The results showed that SGLT2 inhibitors were the only drug that significantly reduced the fracture risk compared to placebo and other drugs (OR 0.85; 95% CI, 0.74-0.98). The other antidiabetic drugs did not show any significant difference from placebo or from each other. The mechanisms behind the effects of SGLT2 inhibitors on bone health are not well understood and may involve changes in calcium, phosphate, sodium, and arginine vasopressin levels in the body. SGLT2 inhibitors demonstrated a favorable skeletal safety profile among antidiabetic drugs. More long-term studies focused on fracture as a primary outcome are needed to fully understand how SGLT2 inhibitors affect bone health and fracture risk in patients with T2DM.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100115"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145046096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypermobile Ehlers-Danlos Syndrome: Cerebrovascular, Autonomic and Neuropathic Features","authors":"Peter Novak MD, PhD ,&nbsp;David M. Systrom MD ,&nbsp;Sadie P. Marciano PA-C ,&nbsp;Alexandra Witte PA-C ,&nbsp;Arabella Warren MD, PhD ,&nbsp;Donna Felsenstein MD ,&nbsp;Matthew P. Giannetti MD ,&nbsp;Matthew J. Hamilton MD ,&nbsp;Jennifer Nicoloro-SantaBarbara PhD ,&nbsp;Mariana Castells MD ,&nbsp;Khosro Farhad MD ,&nbsp;David M. Pilgrim MD ,&nbsp;William J. Mullally MD ,&nbsp;Mark C. Fishman MD ,&nbsp;Jeff M. Milunsky MD ,&nbsp;Aubrey Milunsky MD ,&nbsp;Joel Krier MD","doi":"10.1016/j.ajmo.2025.100111","DOIUrl":"10.1016/j.ajmo.2025.100111","url":null,"abstract":"<div><h3>Background</h3><div>Hypermobile Ehlers-Danlos syndrome (hEDS) affects multiple systems, but comprehensive evaluations of a larger sample of hEDS patients are lacking. The objective of this study was to describe cerebrovascular, autonomic, and neuropathic features of hEDS.</div></div><div><h3>Methods</h3><div>This retrospective case-control study was conducted at Brigham and Women’s Faulkner Hospital between 2016-2023. Data from hEDS patients who completed autonomic testing and skin biopsies were analyzed. Outcome measures include validated surveys (Survey of Autonomic Functions, Neuropathy Total Symptom Score-6 (SAS)) and autonomic function testing (Valsalva maneuver, deep breathing, head-up tilt and sudomotor), cerebrovascular (cerebral blood flow velocity (CBFv) in the middle cerebral artery), respiratory (capnography), and neuropathic (skin biopsies for assessment of small fiber neuropathy) testing and inflammatory/ autoimmune markers.</div></div><div><h3>Results</h3><div>Total 270 hEDS patients were analyzed and compared to 29 healthy controls. Common hEDS complaints (prevalence &gt; 90% ) were orthostatic sudomotor, vasomotor, gastrointestinal, and pain. Orthostatic cerebral blood flow velocity was reduced in 79% of hEDS and correlated with orthostatic dizziness. The head-up tilt test revealed postural tachycardia syndrome (prevalence 33%), hypocapnic cerebral hypoperfusion (22%), orthostatic cerebral hypoperfusion syndrome (18%), and neurogenic orthostatic hypotension (9%). Widespread but mild autonomic failure was present in 90% of hEDS patients on autonomic testing. Small fiber neuropathy using structural criteria was detected in 64%, and using combined structural and functional criteria in 82%.</div></div><div><h3>Conclusions</h3><div>This study provided evidence of cerebrovascular dysregulation with reduced orthostatic cerebral blood flow velocity associated with symptoms of cerebral hypoperfusion, frequent small fiber neuropathy, and widespread but mild autonomic failure in hEDS.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100111"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upadacitinib Monotherapy for Treatment of Pyoderma Gangrenosum","authors":"Mohamad R. Taha ,&nbsp;Harrison P. Nguyen ,&nbsp;Stephen K. Tyring","doi":"10.1016/j.ajmo.2025.100112","DOIUrl":"10.1016/j.ajmo.2025.100112","url":null,"abstract":"<div><div>Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis that results in progressive, painful ulcers most commonly affecting the lower extremities. Although immunosuppressants are frequently used for therapy, there is no standard treatment approach, and recurrences are common. The pathogenesis of PG is believed to involve dysregulation of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway, supporting the potential use of JAK/STAT inhibitors as a treatment option. This case series describes the successful use of upadacitinib, a selective JAK inhibitor, in the management of PG.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100112"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initiating Medications During Hospitalization and Strategies for Ensuring Linkage at Discharge for Patients With Opioid Use Disorder: A Scoping Review","authors":"Austin Drysch ,&nbsp;Kathryn Fink ,&nbsp;Nikhil Sriram ,&nbsp;Marianne Kanaris ,&nbsp;Scott Wu ,&nbsp;Deep Upadhyay ,&nbsp;Katherine Welter ,&nbsp;Lisa Blankenship ,&nbsp;Melissa Bregger ,&nbsp;Kelli Scott ,&nbsp;Brent Schnipke ,&nbsp;Ashti Doobay-Persaud","doi":"10.1016/j.ajmo.2025.100113","DOIUrl":"10.1016/j.ajmo.2025.100113","url":null,"abstract":"<div><div>Hospitalization presents a critical opportunity to initiate medications for opioid use disorder (MOUD) and improve long-term outcomes for patients with opioid use disorder (OUD). While inpatient MOUD initiation significantly reduces mortality and relapse, many patients lack appropriate follow-up care after discharge. This scoping review synthesizes evidence from 52 studies on hospital discharge practices for patients with OUD initiated on MOUD to identify best practices that support continued treatment and recovery. Inpatient addiction consultation services, standardized protocols, and clinician education emerged as key facilitators of MOUD initiation. Transitional care strategies, such as bridge clinics, peer navigation, telemedicine, and structured discharge planning, were associated with increased outpatient linkage, reduced readmissions, and improved retention in treatment. Despite policy advances including X-waiver elimination, systemic barriers persist and disproportionately affect rural and minoritized populations. Multidisciplinary, patient-centered discharge pathways that integrate medical treatment with social support are critical. Effective linkage strategies must address both structural and individual barriers to care. We propose six pillars of MOUD continuity, including early initiation, warm handoffs, peer support, bridge care models, telemedicine integration, and attention to social determinants. Implementing these strategies is essential to closing care gaps and improving outcomes in the evolving landscape of MOUD treatment.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100113"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Sleep Duration and Angina Characteristics in United States Adults","authors":"Maslahuddin HA Alhaque Roomi MD ,&nbsp;Nehal Eid MBBCh ,&nbsp;Aayush Visaria MD","doi":"10.1016/j.ajmo.2025.100109","DOIUrl":"10.1016/j.ajmo.2025.100109","url":null,"abstract":"<div><h3>Background</h3><div>Sleep is now recognized as a key factor in cardiovascular health by the American Heart Association's Life’s Essential 8. However, the relationship between sleep duration and stable angina remains unexplored.</div></div><div><h3>Methods</h3><div>This nationally representative cross-sectional study analyzed data from 18,385 U.S. adults aged 40 and older using the National Health and Nutrition Examination Survey (2005-2018). Daily sleep duration was categorized as &lt;7 hours, 7-8 hours (reference), and &gt;8 hours. Angina was assessed with the Rose Angina Questionnaire and classified by severity (Grade 1 or 2) and pain location (typical vs atypical). Covariates were identified a priori based on previous literature, and clinical relevance.</div></div><div><h3>Results</h3><div>Our study included 18,385 adults with a mean age of 57.6 years (SE 0.16). Out of these, 48.6% were female and 70% were non-Hispanic Whites. A total of 954 (5.2 %) participants reported experiencing angina. Among those with angina, 109 (11%) reported atypical symptoms. Univariate analysis revealed that both short (&lt;7 hours) and long (&gt;8 hours) sleep durations were associated with higher odds of Grade 2 angina compared to adequate sleep (7-8 hours). Adjusted analysis showed significantly higher odds of Grade 2 angina in individuals sleeping &gt;8 hours (OR [95% CI]: 2.16 [1.08-4.32] for females; 2.69 [1.15-6.29] for males). Additionally, sleep &lt;7 hours was associated with a greater likelihood of atypical angina presentation (OR: 1.77 [1.21-3.05]).</div></div><div><h3>Conclusion</h3><div>Our findings suggest that sleeping over 8 hours increases the likelihood of Grade 2 angina, while under 7 hours is linked to atypical presentations, complicating diagnosis. Clinicians could incorporate brief sleep assessments—asking about duration and quality—alongside angina tools like the ROSE questionnaire to identify potential sleep-related factors. While promising, these associations require further research before being translated into definitive clinical guidelines for angina management.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100109"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Statistical Data Replace Pathophysiologic Rationale?: A Belated Question for the Second Quarter of the 21st Century","authors":"Masis Perk","doi":"10.1016/j.ajmo.2025.100110","DOIUrl":"10.1016/j.ajmo.2025.100110","url":null,"abstract":"","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100110"},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Impact of an Expanded MOUD Access Initiative for Patients Hospitalized With Infections From Intravenous Opioid Use","authors":"Jack Keegan ,&nbsp;William Peppard ,&nbsp;Rebecca Bauer ,&nbsp;Mary Beth Alvarez ,&nbsp;Kimberly Stoner ,&nbsp;Jennifer McNeely","doi":"10.1016/j.ajmo.2025.100107","DOIUrl":"10.1016/j.ajmo.2025.100107","url":null,"abstract":"<div><h3>Background</h3><div>Despite their efficacy, medications for opioid use disorder (MOUD) remain underutilized in patients with infections from intravenous opioid use (I-IOU). This study evaluates the impact of an Expanded MOUD Access Initiative (EMAI) on MOUD uptake and other clinical outcomes in patients hospitalized for I-IOU at an institution without addiction medicine consultation.</div></div><div><h3>Methods</h3><div>We performed a retrospective pre-post study of hospital admissions for I-IOU before (January 2019-June 2021) and after (January 2022-December 2023) EMAI introduction. Data was collected via chart review. The EMAI eliminated restrictions on methadone use and established a new order set for buprenorphine inductions. The primary outcome was MOUD receipt; secondary outcomes included patient directed discharge (PDD) and 30-day re-hospitalization.</div></div><div><h3>Results</h3><div>There were 129 hospitalizations prior to the intervention (control) and 98 after (EMAI). MOUD receipt was significantly higher in the EMAI group (75.5% vs 31.0%; OR, 6.86 [95% CI, 3.84-12.61]). In patients not receiving MOUD prior to admission (n = 176), new inductions occurred more frequently in the EMAI group (68.0% vs 11.9%; OR, 15.76 [95% CI, 7.50-35.78]). PDD was lower in the EMAI group (23.5% vs 48.8%; OR, 0.32 [95% CI, 0.10-0.57]), as was 30-day re-hospitalization (12.2% vs 22.5%; OR, 0.48 [95% CI, 0.22-0.98]). In a multivariable logistic regression model, the EMAI was the only variable to show a statistically significant association with MOUD receipt (aOR, 6.89 [95% CI, 3.75-13.11]).</div></div><div><h3>Conclusions</h3><div>The EMAI was associated with increased MOUD uptake, reduced PDD, and fewer 30-day re-hospitalizations despite the lack of addiction medicine consultation.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100107"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital-Based Stigma Practices Towards Individuals With Opioid Use Disorder: A Qualitative Study in Austin, Texas","authors":"Nicholaus J. Christian MD, MBA ,&nbsp;Amber Baysinger MD, PhD ,&nbsp;Richard Bottner DHA, PA-C ,&nbsp;Cody Cowley MD ,&nbsp;Rebecca Nekolaichuk MD ,&nbsp;Phil Owen RSPS ,&nbsp;Blake Smith MD ,&nbsp;Kimberly L. Sue MD, PhD","doi":"10.1016/j.ajmo.2025.100106","DOIUrl":"10.1016/j.ajmo.2025.100106","url":null,"abstract":"<div><h3>Background</h3><div>Individuals with opioid use disorder (OUD) commonly face stigma when receiving healthcare. Although experienced stigma of patients with OUD in hospital settings is linked to worse treatment outcomes, less is known about the stigmatizing care practices of hospital-based providers that result in experienced stigma.</div></div><div><h3>Objective</h3><div>This study aimed to explore hospital-based stigma experiences and positive care experiences of people with OUD to identify stigmatizing and nonstigmatizing care practices to inform hospital-based care.</div></div><div><h3>Design</h3><div>This was a qualitative study based on semi-structured, in-person focus groups.</div></div><div><h3>Participants</h3><div>Participants were people who self-identified as being in recovery from opioid use disorder recruited through a community recovery organization in Austin, TX.</div></div><div><h3>Approach</h3><div>Focus groups followed a semi-structured interview guide encouraging discussion of stigmatizing healthcare experiences. We used applied thematic analysis in a systematic, inductive approach to categorize themes around hospital-based care experiences.</div></div><div><h3>Key Results</h3><div>Among participants (n = 18), stigmatizing experiences reflected the following hospital-based care practice themes: using non-person-first language, ignoring pain, labeling as “drug-seeking,” and not valuing the lived expertise of patients. These practices resulted in fear/avoidance of care, distrust of the care team, and internalized stigma. On the other hand, using recovery-oriented language, being polite, and engaging in shared decision making resulted in open communication with providers and trust of the care team.</div></div><div><h3>Conclusions</h3><div>Stigma experienced in hospital settings has significant consequences for patients with OUD. Hospital systems must implement policies that promote patient-centered practices and avoid stigmatizing practices to improve hospital-based care delivery for people with OUD.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"14 ","pages":"Article 100106"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}