General Internal Medicine Research Papers (original) (raw)

Top Papers
Most Cited Papers
Most Downloaded Papers
Newest Papers
People
- by
- •
- Publishing, Medical Education, General Internal Medicine, United States
- by Eric Poon
- •
- Communication, Primary Health Care, Patient Safety, Quality of Mental Health Care
- by Dennis Novack
- •
- General Internal Medicine, Social Support, Empathy, Therapeutics
- by Danielle Hessler and +1
- •
- Self Care, General Internal Medicine, Treatment Outcome, Humans

Burnout in medicine is a substantial problem with adverse consequences for both physicians and the patients who they treat. In our efforts to combat burnout, we must consider every tool at our disposal, since a complex problem requires a multifaceted approach. Recognizing that many physicians derive meaning from spirituality and religion, attempts to improve physician and trainee wellness should acknowledge the importance of religion and spirituality for self-care more than has heretofore been the case.

- by Kristin Collier
- •
- General Internal Medicine, Medicine, Clinical Sciences
- by Kathryn Magruder
- •
- Primary Care, Mental Health, Depression, General Internal Medicine
- by Richard Mularski and +1
- •
- Pain, Health Care, Quality of Mental Health Care, General Internal Medicine

Patient misunderstanding of prescription drug label instructions is a common cause of unintentional misuse of medication and adverse health outcomes. Those with limited literacy and English proficiency are at greater risk. To test the effectiveness of a patient-centered drug label strategy, including a Universal Medication Schedule (UMS), to improve proper regimen use and adherence compared to a current standard. Two-arm, multi-site patient-randomized pragmatic trial. English- and Spanish-speaking patients from eight community health centers in northern Virginia who received prescriptions from a central-fill pharmacy and who were 1) ≥30 years of age, 2) diagnosed with type 2 diabetes and/or hypertension, and 3) taking ≥2 oral medications. A patient-centered label (PCL) strategy that incorporated evidence-based practices for format and content, including prioritized information, larger font size, and increased white space. Most notably, instructions were conveyed with the UMS, which ...

- by ruth parker
- •
- Health Literacy, Medication Adherence, General Internal Medicine, Humans
- by Jennifer Braden
- •
- General Internal Medicine, Adolescent, Humans, United States
- by Jeffrey Rothschild
- •
- Decision Making, General Internal Medicine, Risk Management, Critical Care
- by Kathryn Magruder
- •
- Research Design, Primary Health Care, General Internal Medicine, Medicine

Organizational factors have long been suspected to have the greatest influence on individual and group behavior in the workplace, although there is little research on their influence in mining workplaces. In addition, there is little research on the influence of organizational factors on residual risk management in the mining industry. Consequently, a Systematic Literature Review (SLR) is needed in order to explore and understand this gap. This paper is a protocol developed using guidance from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 to update a previous systematic review on a similar topic. The SLR protocol provides information related to the three sections (Administrative Information, Introduction and Methods) suggested by the PRISMA-P 2015. Eligibility criteria is divided into inclusion and exclusion criteria, which also provides the scope of the review. The search strategy will involve identifying studies published between 1...

- by Manikam Pillay
- •
- Educational Technology, Higher Education, Embedded Systems, Aging
- by Terence Keane
- •
- Primary Care, Accessibility, Primary Health Care, Chronic Pain
- by Jan D Carline
- •
- Graduate Education, Medical Education, Medical Ethics, General Internal Medicine
- by Jacqueline Pugh
- •
- Primary Care, Health Behavior, Primary Health Care, Self Care
- by Susan Zickmund and +1
- •
- Health Care, Quality of life, General Internal Medicine, Social Support
- by Rajiv Thakkar and +1
- •
- General Internal Medicine, Humans, Data Collection, Clinical Sciences
- by Ronald Epstein
- •
- General Internal Medicine, Clinical Sciences
- by Mahmoud Ali
- •
- General Internal Medicine, Humans, General, Bone marrow
- by Manasi Tirodkar
- •
- Primary Health Care, General Internal Medicine, Qualitative Research, Medicine

Weight management medications (WMM) are underutilized as an adjunct to behavioral and lifestyle interventions. In fiscal years 2014-2015, a total of approximately 2500 veterans-a mere 2% of veterans receiving care from the Veterans Health Administration (VHA)-eligible for a WMM received a prescription for one. A State of the Art Conference on Weight Management workgroup, focused on pharmacotherapy, developed evidence-based recommendations and strategies to foster the appropriate use of WMM in the VHA. The workgroup identified patient, prescriber, and health system barriers to and facilitators for prescribing WMM. Barriers included patient and provider concerns about medication safety and efficacy, limited involvement of primary care, restrictive medication criteria for use (CFU), and skepticism among providers regarding the safety and efficacy of WMM and the perception of obesity as a disease. Potential facilitators for removing barriers included patient and provider education about...

- by Donna Ames
- •
- General Internal Medicine, Clinical Sciences
- by Alexa Miller and +2
- •
- Data Analysis, Medical Education, Content Analysis, General Internal Medicine

OBJECTIVE: To measure the prevalence of sleep problems in a working population and examine their association with health problems, health-related quality-of-life measures, work-related problems, and medical expenditures. Also, to explore the usefulness of a sleep-problems screen for mental health conditions and underlying sleep disorders. DESIGN: Cross-sectional survey administered via voice mail and telephone interview. SETTING: A San Francisco Bay Area telecommunications firm. PARTICIPANTS: Volunteer sample of 588 employees who worked for a minimum of six months at the company and were enrolled in its fee-for-service health plan. MEASUREMENTS AND MAIN RESULTS: Thirty percent of respondents reported currently experiencing sleep problems and were found to have worse functioning and well-being (general health, cognitive functioning, energy), more work-related problems (decreased job performance and lower satisfaction, increased absenteeism), and a greater likelihood of comorbid physical and mental health conditions than were the respondents who did not have sleep problems. They also demonstrated a trend toward higher medical expenditures. CONCLUSIONS: Self-perceived sleep problems were common among the respondents and were associated with poorer health and health-related quality of life. A single question about sleep problems may serve as an effective screen for identifying primary care patients with mental health problems, as well as underlying sleep disorders.

- by Po Don
- •
- Primary Care, Mental Health, Quality of life, Health Planning
- by Kathryn McDonald
- •
- Computer Science, Technology, Medical Informatics, Evidence Based Medicine
- by Kathryn Goggins
- •
- Health Literacy, General Internal Medicine, Humans, Female
- by Dennis Novack
- •
- Primary Care, Domestic Violence, Health Care, General Internal Medicine

OBJECTIVE: To develop a valid, reliable instrument to measure the functional health literacy of patients. DESIGN: The Test of Functional Health Literacy in Adults (TOFHLA) was developed using actual hospital materials. The TOFHLA consists of a 50-item reading comprehension and 17-item numerical ability test, taking up to 22 minutes to administer. The TOFHLA, the Wide Range Achievement Test-Revised (WRAT-R), and the Rapid Estimate of Adult Literacy in Medicine (REALM) were administered for comparison. A Spanish version was also developed (TOFHLA-S). SETTING: Outpatient settings in two public teaching hospitals. PATIENTS: 256 English- and 249 Spanish-speaking patients were approached. 78% of the English- and 82% of the Spanish-speaking patients gave informed consent, completed a demographic survey, and took the TOFHLA or TOFHLA-S. RESULTS: The TOFHLA showed good correlation with the WRAT-R and the REALM (correlation coefficients 0.74 and 0.84, respectively). Only 52% of the English speakers completed more than 80% of the questions correctly. 15% of the patients could not read and interpret a prescription bottle with instructions to take one pill by mouth four times daily, 37% did not understand instructions to take a medication on an empty stomach, and 48% could not determine whether they were eligible for free care. CONCLUSIONS: The TOFHLA is a valid, reliable indicator of patient ability to read health-related materials. Data suggest that a high proportion of patients cannot perform basic reading tasks. Additional work is needed to determine the prevalence of functional health illiteracy and its effect on the health care experience.

- by Mark Williams
- •
- Health Care, Health Literacy, Informed Consent, General Internal Medicine

Burnout affects nearly half of all U.S. nurses and physicians, and has been linked to poor outcomes such as worse patient safety. The most common measure of burnout is the well-validated Maslach Burnout Inventory (MBI). However, the MBI is proprietary and carries licensing fees, posing challenges to routine or repeated assessment. To compare a non-proprietary, single-item burnout measure to a single item from the MBI Emotional Exhaustion (MBI:EE) subscale that has been validated as a standalone burnout measure. Cross-sectional online survey. A sample of primary care providers (PCPs), registered nurses, clinical associates (e.g., licensed practical nurses (LPNs), medical technicians), and administrative clerks in the Veterans Health Administration surveyed in 2012. We compared a validated one-item version of the MBI:EE and a non-proprietary single-item burnout measure used in the Physician Work Life Study. We calculated kappa statistics, sensitivity and specificity, positive predicti...

- by David Mohr
- •
- Psychometrics, Primary Health Care, General Internal Medicine, Risk assessment

Objectives To better understand the causes of racial disparities in health care, we reviewed and synthesized existing evidence related to disparities in the “equal access” Veterans Affairs (VA) health care system. Methods We systematically reviewed and synthesized evidence from studies comparing health care utilization and quality by race within the VA. Results Racial disparities in the VA exist across a wide range of clinical areas and service types. Disparities appear most prevalent for medication adherence and surgery and other invasive procedures, processes that are likely to be affected by the quantity and quality of patient–provider communication, shared decision making, and patient participation. Studies indicate a variety of likely root causes of disparities including: racial differences in patients’ medical knowledge and information sources, trust and skepticism, levels of participation in health care interactions and decisions, and social support and resources; clinician judgment/bias; the racial/cultural milieu of health care settings; and differences in the quality of care at facilities attended by different racial groups. Conclusions Existing evidence from the VA indicates several promising targets for interventions to reduce racial disparities in the quality of health care.

- by ahmed ibrahim
- •
- Health Care, Prejudice, Medication Adherence, Treatment
- by Leah Karliner
- •
- General Internal Medicine, General, Interpreters, Clinical Sciences
- by Stefan Gravenstein
- •
- Dementia, General Internal Medicine, Executive Function, Prospective studies

- by David Baker
- •
- Health Care, Health Literacy, Informed Consent, General Internal Medicine
- by William Ian Miller
- •
- Organizational Culture, Health Care, Relevance Theory, Quality of life

Objective To determine whether lower levels of empathy among a sample of medical students in the United States are associated with personal and professional distress and to explore whether a high degree of personal well-being is associated with higher levels of empathy. Design Multi-institutional, cross-sectional survey. Setting All medical schools in Minnesota (a private medical school, a traditional public university, and a public university with a focus in primary care). Participants A total of 1,098 medical students. Measurements Validated instruments were used to measure empathy, distress (i.e., burnout and symptoms of depression), and well-being (high quality of life). Results Medical student empathy scores were higher than normative samples of similarly aged individuals and were similar to other medical student samples. Domains of burnout inversely correlated with empathy (depersonalization with empathy independent of gender, all P < .02, and emotional exhaustion with emotive empathy for men, P = .009). Symptoms of depression inversely correlated with empathy for women (all P ≤ .01). In contrast, students’ sense of personal accomplishment demonstrated a positive correlation with empathy independent of gender (all P < .001). Similarly, achieving a high quality of life in specific domains correlated with higher empathy scores (P < .05). On multivariate analysis evaluating measures of distress and well-being simultaneously, both burnout (negative correlation) and well-being (positive correlation) independently correlated with student empathy scores. Conclusions Both distress and well-being are related to medical student empathy. Efforts to reduce student distress should be part of broader efforts to promote student well-being, which may enhance aspects of professionalism. Additional studies of student well-being and its potential influence on professionalism are needed.

- by Karen Lawson
- •
- Primary Care, Ethics, Quality of life, General Internal Medicine
- by Ruth Parker
- •
- Health Care, Health Literacy, Informed Consent, General Internal Medicine
- by Emily Williams
- •
- Primary Care, Communication, Conversation Analysis, Consumption
- by Curt Furberg and +1
- •
- Decision Making, Quality of life, Treatment, General Internal Medicine
- by Kazi Jack
- •
- Decision Making, Health Care, General Internal Medicine, Survey Research

- by David Baker
- •
- Health Care, Health Literacy, Informed Consent, General Internal Medicine
- by Richard Deyo
- •
- General Internal Medicine, Medicine, Humans, General
- by James Martindale and +1
- •
- General Internal Medicine, Internal Medicine, General, United States
- by D. Lakkireddy
- •
- General Internal Medicine, Clinical Sciences
- by Alice Chen
- •
- Communication, Health Care, General Internal Medicine, Language
- by Lisa Rubenstein
- •
- Algorithms, Primary Care, Mental Health, Primary Health Care
- by Kent Sheets
- •
- General Internal Medicine, Curriculum, Humans, Internal Medicine