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Capsule Commentary on Pilla et al., Predictors of Insulin Initiation in Patients with Type 2 Diabetes: an Analysis of the Look AHEAD Randomized Trial
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 22, 2018 Category: Internal Medicine Source Type: research

Patient and Clinician Perspectives on Shared Decision-making in Early Adopting Lung Cancer Screening Programs: a Qualitative Study
ConclusionsDue to multiple perceived barriers, patient-clinician conversations about lung cancer screening may fall short of guideline-recommended shared decision-making supported by a decision aid. Consequently, patients may be left uncertain about lung cancer screening ’s rationale, trade-offs, and process. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 21, 2018 Category: Internal Medicine Source Type: research

Seasonal Variation in Readmission Risk for Patients Hospitalized with Cardiopulmonary Conditions
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 20, 2018 Category: Internal Medicine Source Type: research

The Long-Term Uninsured Were Less Likely than the Short-Term Uninsured to Gain Insurance in 2014
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 20, 2018 Category: Internal Medicine Source Type: research

An All-Payer Risk Model for Super-Utilization in a Large Safety Net System
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 20, 2018 Category: Internal Medicine Source Type: research

So Tired: Predictive Utility of Baseline Sleep Screening in a Longitudinal Observational Survey Cohort of First-Year Residents
The objective of this study was to assess change in resident sleep during training and to evaluate utility of baseline sleep screening in predicting future sleep impairment.DesignThis is a prospective observational repeated-measures survey  study.ParticipantsThe participants comprised PGY-1 residents across multiple specialties at Partners HealthCare hospitals.Main MeasuresMain measures used for this study were demographic queries and two validated scales: the Pittsburgh Sleep Quality Index (PSQI), measuring sleep quality, and the Epworth Sleepiness Scale (ESS), measuring excessive daytime sleepiness.Key ResultsTwo hu...
Source: Journal of General Internal Medicine - February 20, 2018 Category: Internal Medicine Source Type: research

Can your patients with heart failure see? The prevalence of visual impairment among adults with heart failure
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 20, 2018 Category: Internal Medicine Source Type: research

Capsule Commentary on Bremmer et. al., Impact of Procalcitonin Guidance on Management of Adults Hospitalized with Chronic Obstructive Pulmonary Disease Exacerbations
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 20, 2018 Category: Internal Medicine Source Type: research

“Lethal talk or healthful words? The prescription for empathetic utterance”
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 20, 2018 Category: Internal Medicine Source Type: research

Longitudinal Analysis of Racial/Ethnic Trends in Quality Outcomes in Community Health Centers, 2009 –2014
AbstractBackgroundTo monitor progress towards eliminating health disparities, community health centers have reported on hypertension control, diabetes control, and birthweight by race and ethnicity since 2008.ObjectiveTo evaluate racial/ethnic time trends in quality outcomes in health centers and to assess both within- and between-center disparities in outcomes.Design and SampleUsing 2009 –2014 data from all US health centers (n = 1047 centers, serving 19.6 million patients/year), we evaluated racial/ethnic time trends in quality outcomes for health centers and assessed within- and between-center disparitie...
Source: Journal of General Internal Medicine - February 16, 2018 Category: Internal Medicine Source Type: research

Reducing Long-term Opioid Use in the Veterans Health Administration
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 15, 2018 Category: Internal Medicine Source Type: research

Application and impact of run-in studies
ConclusionTrials with run-in phases provided similar estimates for medication efficacy and safety compared to trials without run-in phases. Because run-in phases are costly and time-consuming, these results call their utility into question for clinical trials of short duration. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 15, 2018 Category: Internal Medicine Source Type: research

Capsule Commentary on Robinson et al.: A Randomized Trial on the Efficacy of Mastery Learning on Primary Care Providers ’ Melanoma Opportunistic Screening Skills and Practice
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 15, 2018 Category: Internal Medicine Source Type: research

Capsule Commentary on Goddu et. al., Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 15, 2018 Category: Internal Medicine Source Type: research

Lethal Talk
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 15, 2018 Category: Internal Medicine Source Type: research

Factors of U.S. Hospitals Associated with Improved Profit Margins: An Observational Study
ConclusionsDifferential price increases have led to improved margins for some hospitals over time. Where significant price increases are not possible, hospitals will have to become more efficient to maintain profitability. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 14, 2018 Category: Internal Medicine Source Type: research

Professionalism Framings Across Medical Schools
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 12, 2018 Category: Internal Medicine Source Type: research

Gendered Expectations: Do They Contribute to High Burnout Among Female Physicians?
AbstractPatients have differing expectations of female versus male physicians. Female patients tend to seek more empathic listening and longer visits, especially with female physicians; however, female doctors are not provided more time for this. Female doctors have more female patients than male doctors, and more patients with psychosocial complexity. We propose that gender differences in patient panels and gendered expectations of female physicians may contribute to the high rate of burnout among female clinicians, as well as to the many female physicians working part-time to reduce stress in their work lives. We propose...
Source: Journal of General Internal Medicine - February 12, 2018 Category: Internal Medicine Source Type: research

Trends in Diabetes Treatment and Monitoring among Medicare Beneficiaries
ConclusionsThe use of metformin and long-acting insulin have increased substantially among elderly Medicare patients with diabetes, but a substantial subgroup continues to receive costly and complex treatment regimens. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 9, 2018 Category: Internal Medicine Source Type: research

The Effectiveness of Self-Management Interventions for Individuals with Low Health Literacy and/or Low Income: A Descriptive Systematic Review
DiscussionFindings suggest that self-management interventions in populations with low income or low health literacy are most effective when three to four self-management skills are utilized, particularly when problem-solving is targeted. Healthcare providers and researchers can use these findings to develop education strategies and tools for populations with low income or low health literacy to improve chronic illness self-management. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 9, 2018 Category: Internal Medicine Source Type: research

Evaluating the Quality of Patient Decision-Making Regarding Post-Acute Care
ConclusionsUnderstanding and intervening to improve the quality of decision-making regarding post-acute care supports is essential for improving outcomes of hospitalized older adults. Our results suggest that simply providing information is not sufficient; rather, incorporating key contextual factors and improving the decision-making process for both patients and clinicians are also essential. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 9, 2018 Category: Internal Medicine Source Type: research

Treatment Initiation for New Episodes of Depression in Primary Care Settings
ConclusionsScreening for depression in primary care is a positive step towards improving detection, treatment, and outcomes for depression. However, study results indicate that treatment initiation remains suboptimal, and disparities persist. A better understanding of patient factors, and  particularly system-level factors, that influence treatment initiation is needed to inform efforts by heath care systems to improve depression treatment engagement and to reduce disparities. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 8, 2018 Category: Internal Medicine Source Type: research

Women ’s Healthcare Utilization Following Routine Screening for Past-Year Intimate Partner Violence in the Veterans Health Administration
ConclusionsWomen who screen positive for past-year IPV have high rates of return to outpatient visits following screening, presenting opportunities for follow-up support. Higher rates of emergency department utilization and inpatient stays among women screening IPV+ may indicate adverse health outcomes related to IPV experience. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 8, 2018 Category: Internal Medicine Source Type: research

General Internists in Pursuit of Diagnostic Excellence in Primary Care: a #ProudtobeGIM Thread That Unites Us All
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 8, 2018 Category: Internal Medicine Source Type: research

Keys to career success: resources and barriers identified by early career academic hospitalists
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 8, 2018 Category: Internal Medicine Source Type: research

Dangers and Opportunities of Direct-to-Consumer Advertising
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 8, 2018 Category: Internal Medicine Source Type: research

Capsule Commentary on Landon et al., “Trends in Diabetes Treatment and Monitoring Among Medicare Beneficiaries”
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 8, 2018 Category: Internal Medicine Source Type: research

Capsule Commentary on Ratcliffe et al., “Service and Education: the Association Between Workload, Patient Complexity, and Teaching on Internal Medicine Inpatient Services”
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 8, 2018 Category: Internal Medicine Source Type: research

Individualizing PSA Monitoring Among Older Prostate Cancer Survivors
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 7, 2018 Category: Internal Medicine Source Type: research

Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial
AbstractBackgroundHospitals are standard of care for acute illness, but hospitals can be unsafe, uncomfortable, and expensive. Providing substitutive hospital-level care in a patient ’s home potentially reduces cost while maintaining or improving quality, safety, and patient experience, although evidence from randomized controlled trials in the US is lacking.ObjectiveDetermine if home hospital care reduces cost while maintaining quality, safety, and patient experience.DesignRandomized controlled trial.ParticipantsAdults admitted via the emergency department with any infection or exacerbation of heart failure, chronic...
Source: Journal of General Internal Medicine - February 6, 2018 Category: Internal Medicine Source Type: research

Characteristics of Patient-Centered Medical Home Initiatives that Generated Savings for Medicare: a Qualitative Multi-Case Analysis
ConclusionsDesigners of future PCMH initiatives may increase their likelihood of generating net savings by incorporating the demonstration features we identified. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 5, 2018 Category: Internal Medicine Source Type: research

Electronic Health Records: a “Quadruple Win,” a “Quadruple Failure,” or Simply Time for a Reboot?
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 5, 2018 Category: Internal Medicine Source Type: research

Balancing the Rights to Protection and Participation: A Call for Expanded Access to Ethically Conducted Correctional Health Research
AbstractIncarcerated individuals, over 95% of whom are eventually released, experience high burdens of chronic disease and behavioral health and social risk factors. Understanding the health needs of this population is critical to ensuring that general medicine physicians in prisons and in the community are adequately prepared to meet those needs. However, people in prison are significantly underrepresented in health research. In response to historical exploitation of prisoners in medical experimentation, federal guidelines appropriately require additional oversight for, and limit the scope of, research in prisons. Yet, ac...
Source: Journal of General Internal Medicine - February 5, 2018 Category: Internal Medicine Source Type: research

A Randomized Trial on the Efficacy of Mastery Learning for Primary Care Provider Melanoma Opportunistic Screening Skills and Practice
AbstractBackgroundEarly detection of melanoma represents an opportunity to reduce the burden of disease among people at increased risk for melanoma.ObjectiveTo develop and demonstrate the efficacy of online training.DesignRandomized educational trial.ParticipantsPrimary care providers (PCPs).InterventionMastery learning course with visual and dermoscopic assessment, diagnosis and management, and deliberate practice with feedback to reach a minimum passing standard.Main MeasuresPre-test/post-test diagnostic accuracy. Referral of concerning lesions for 3  months before and after the educational intervention.Key ResultsA...
Source: Journal of General Internal Medicine - February 5, 2018 Category: Internal Medicine Source Type: research

Capsule Commentary on Murray et al. Antihypertensive Medication and Dementia Risk in Older Adult African-Americans with Hypertension: a Prospective Cohort Study
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 5, 2018 Category: Internal Medicine Source Type: research

Prediction of Future Chronic Opioid Use Among Hospitalized Patients
AbstractBackgroundOpioids are commonly prescribed in the hospital; yet, little is known about which patients will progress to chronic opioid therapy (COT) following discharge. We defined COT as receipt of ≥ 90-day supply of opioids with
Source: Journal of General Internal Medicine - February 5, 2018 Category: Internal Medicine Source Type: research

Adequacy of Depression Treatment in Spouses of Cancer Survivors: Findings From a Nationally Representative US Survey
ConclusionsSpouses of cancer survivors with depression may be at increased risk of non-guideline-concordant depression treatment, particularly in rural areas. The findings have implications for identifying and educating individuals with depression in primary care and other clinical areas. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 5, 2018 Category: Internal Medicine Source Type: research

Impact of Procalcitonin Guidance on Management of Adults Hospitalized with Chronic Obstructive Pulmonary Disease Exacerbations
ConclusionsUtilizing PCT guidance in the management of COPD exacerbations was associated with a decreased total duration of antibiotic therapy and hospital LOS without negatively impacting hospital readmissions. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 5, 2018 Category: Internal Medicine Source Type: research

A Randomized Trial to Improve Communication between Patients and Providers in a Primary Care Walk-In Clinic
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 5, 2018 Category: Internal Medicine Source Type: research

Enhancing Resident Well-being: Illuminating the Path Forward
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 1, 2018 Category: Internal Medicine Source Type: research

Team-Based Health Information Exchange Use Increased Mammography Documentation and Referral in an Academic Primary Care Practice: An Interrupted Time Series
AbstractBackgroundFew studies have examined the impact of health information exchanges (HIE) on quality in ambulatory settings.MethodsFrom September 29, 2014, to September 4, 2015, we conducted an interrupted time series analysis of query-based use of the state HIE as part of team-based care to improve mammography screening in an academic primary care practice. Women aged 50 –74 years with a practice visit and who were eligible for mammography were included. We conducted non-parametric data analysis using LOESS, followed by ARIMA analysis.ResultsDuring the study period, there were 2020 visits among 904 eligible ...
Source: Journal of General Internal Medicine - February 1, 2018 Category: Internal Medicine Source Type: research

Service and Education: The Association Between Workload, Patient Complexity, and Teaching on Internal Medicine Inpatient Services
AbstractBackgroundAttending rounds remain the primary venue for formal teaching and learning at academic medical centers. Little is known about the effect of increasing clinical demands on teaching during attending rounds.ObjectiveTo explore the relationships among teaching time, teaching topics, clinical workload, and patient complexity variables.DesignObservational study of medicine teaching teams from September 2008 through August 2014. Teams at two large teaching hospitals associated with a single medical school were observed for periods of 2 to 4  weeks.ParticipantsTwelve medicine teaching teams consisting of one...
Source: Journal of General Internal Medicine - February 1, 2018 Category: Internal Medicine Source Type: research

Capsule Commentary on Sanz et al., A Composite of Functional Status and Pneumonia Severity Index Improves the Prediction of Pneumonia Mortality in Older Patients
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - February 1, 2018 Category: Internal Medicine Source Type: research

Recruiting Rural Healthcare Providers Today: a Systematic Review of Training Program Success and Determinants of Geographic Choices
DiscussionThe review provides insight into the relative importance of demographic characteristics and motivational factors in determining which providers should be targeted to maximize return on recruitment efforts. Existing programs exposing students to rural practice during their training are promising but require further refining. Public policy must include a specific focus on the trajectory of the healthcare workforce and must consider alternative models of healthcare delivery that promote a more diverse, interdisciplinary combination of providers. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - January 30, 2018 Category: Internal Medicine Source Type: research

Mortality Associated with Metformin Versus Sulfonylurea Initiation: A Cohort Study of Veterans with Diabetes and Chronic Kidney Disease
ConclusionsInitiation of metformin versus a sulfonylurea among individuals with type 2 diabetes and CKD was associated with a substantial reduction in mortality, in terms of both relative and absolute risk reduction. The largest absolute risk reduction was observed among individuals with moderately –severely reduced eGFR (30–44 mL/min/1.73m2). (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - January 30, 2018 Category: Internal Medicine Source Type: research

Accelerating the Implementation of Social Determinants of Health Interventions in Internal Medicine
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - January 30, 2018 Category: Internal Medicine Source Type: research

Pivot and Cluster: An Exercise in Clinical Reasoning
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - January 30, 2018 Category: Internal Medicine Source Type: research

What Does ‘Unpaid Consultant’ Signify? A Survey of Euphemistic Language in Conflict of Interest Declarations
ConclusionsDisclosing ‘unpaid’ relationships with for-profit companies typically signals but does not explain competing interests. Our findings challenge editors to respond to the increasing use of language that may conceal rather than illuminate conflicts of interest. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - January 30, 2018 Category: Internal Medicine Source Type: research

Acute Shoulder Pain Followed by Shoulder Weakness and Atrophy: A Characteristic Presentation of Parsonage-Turner Syndrome
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - January 30, 2018 Category: Internal Medicine Source Type: research

Capsule Commentary on Merlin et al., Managing Concerning Behaviors in Patients Prescribed Opioids for Chronic Pain: A Delphi Study
(Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - January 30, 2018 Category: Internal Medicine Source Type: research