Internal Medicine Practice Research Articles

Holistic Patient Care: A Narrative Review on the Synergy of Internal Medicine, Anesthesiology, and Surgical Practices

Introduction: holistic patient care, which integrates the efforts of Internal Medicine, Anesthesiology, and Surgical Practices, has been shown to improve patient outcomes across the continuum of care. This review aimed to explore the synergy between these specialties and highlight how their collaboration contributes to comprehensive, patient-centered care.Method: a narrative review was conducted using peer-reviewed literature from databases such as PubMed, Scopus, and Google Scholar. The search focused on articles published in the last 15 years, using terms related to interdisciplinary collaboration in healthcare. Data from relevant studies were synthesized and grouped into preoperative, intraoperative, and postoperative phases, with emphasis on how each specialty contributes to holistic care.Results: the review demonstrated that collaboration between these specialties is essential for optimizing preoperative risk management, ensuring intraoperative stability, and enhancing postoperative recovery. Internal Medicine played a key role in managing chronic conditions preoperatively, while Anesthesiology tailored anesthesia plans and managed perioperative pain. Surgical Practices, guided by insights from the other specialties, executed patient-centered surgeries. Despite the benefits, challenges such as communication barriers and resource limitations were identified.Conclusion: this review highlighted the critical role of interdisciplinary collaboration in holistic patient care. While the synergy between Internal Medicine, Anesthesiology, and Surgical Practices improved patient outcomes, addressing communication challenges and resource constraints is essential for further enhancing care quality.

The Organization of Academic General Internal Medicine Practice at the Top Primary Care Schools.

While prior studies have explored staffing infrastructure for primary care practices in general, little is known about the range of academic primary care practice models and supports available for academic general internists. To characterize the range of practice arrangements and expectations for attending academic physicians in general internal medicine (GIM) practices at the top 22 medical schools across the USA. Cross-sectional survey administered electronically between October 30, 2022, and December 28, 2022. Clinical leaders in GIM at the top 22 primary care medical schools, as identified by the 2023 US News and World Report Rankings. Clinical load, productivity expectations, cross-coverage, and team-based care models. Twenty-two leaders responded, representing 68% (15/22) of medical schools surveyed. The practices were mostly in urban locations (18/22, 82%) and 86% (19/22) included residents. Practices ranged from 7 to 200 PCPs and from 3 to 112 clinical FTEs. A full-time (1.0 FTE) clinical role for academic attending GIM physicians entailed a median of 9 (IQR 8, 10) weekly half-day clinic sessions, with a median panel size expectation of 1600 (IQR 1450, 1850) patients and a median yearly RVU expectation of 5200 (IQR 4161, 5891) yearly RVUs generated. Staff support was most commonly present for prescription refills and patient portal message checks. It was less commonly available for time sensitive form completion. Occasional clinical coverage for other physicians was an expectation at all practices. In this study, we characterize the organization of and supports available in academic GIM practices affiliated with the top primary care medical schools. Our findings provide comparative information for leaders of academic GIM practices seeking to enhance primary care delivery for their faculty and trainees. They also highlight areas where standardization may be beneficial across academic GIM.

Malpractice rates are lower for women physicians compared to men physicians

Background Previous literature has shown that women physicians are less likely to be involved in medical malpractice litigation than male physicians. Methods This study sought to examine the differences in malpractice experience by provider gender by using closed medical malpractice claims from 2011 through 2020. Results We found that after adjusting for the number of claims and dollar losses per full time equivalents worked, female physicians experienced fewer and less costly claims than male physicians ( p < .001). Specific specialties had a significant relationship between claim frequency and provider gender, which included general surgery ( p = .01), obstetrics ( p = .001), gynecology ( p = .04), internal medicine and family general practice ( p < .001). Conclusion The results from this analysis support the prior findings that male physicians experience a higher rate of malpractice claims. Therefore, there is an opportunity to learn how women providers achieve lower malpractice risk to inform clinical practice recommendations.

Social Isolation and Healthcare Utilization in Older Adults Living With Dementia and Mild Cognitive Impairment in the United States.

Social isolation is commonly experienced by older people and is associated with adverse health outcomes. Little is known about the influence of social isolation on the risk of acute care utilization among people living with mild cognitive impairment (MCI) or dementia. Our objective was to investigate the impact of social isolation on the risk of death, hospitalization, and emergency department (ED) use among people living with MCI or dementia who are followed in our Community Internal Medicine practice at Mayo Clinic, Rochester, Minnesota. We included people living with MCI or dementia, 55 years and older, who had a clinic visit between June 1, 2019, and June 30, 2021, and who had completed questions about social connections. The risk of death, hospitalization, and ED use was examined by levels of social connection (socially isolated, moderately isolated, moderately integrated, or socially integrated). Of 2,320 people included (1,010 with MCI and 1,310 with dementia), 455 (19.6%) were classified as socially isolated and 591 (25.5%) were moderately isolated. Compared with those who were socially integrated, people who were socially isolated were at higher risk of death, hospitalization, and ED visits (p < .001). Social isolation is associated with an increased risk of acute health care utilization and death in people living with MCI or dementia. Interventions to address social isolation in this population are needed.

COVID-19 immunization status in children compared to their parents: a retrospective review at an upstate NY medicine/pediatrics practice

BackgroundThis study aimed to investigate the relationship between parent and child COVID-19 immunization series completion using vaccine records.MethodsA cross-sectional chart review was performed on parent and child patients at the Albany Medical Center Internal Medicine and Pediatrics practice. Patient and parent demographic data, COVID-19 immunization status, and health care worker status was collected. Patient data was further separated into 2 cohorts to account for vaccine eligibility among child age groups, with 5–11 years and 6 months-4 years cohorts. Chi square or Fisher’s exact test was used where appropriate.ResultsAcross both cohorts, 371 child patients were identified and cross-matched with corresponding parents. Neither cohort offered evidence linking child immunization series completion with the child’s race, ethnicity, or county of residence. However, rates of series completion were higher for children with private insurance versus public options in both the 5–11 years and 6 months-4 years cohorts (both p < 0.001). Children were more likely to be immunized against COVID-19 if their parents were fully immunized against COVID-19 (both p < 0.05). Children aged 6 months-4 years were more likely to be immunized against COVID-19 if their parent was a health care worker (p = 0.038).ConclusionsThis study demonstrates a significance between child insurance status, as well as between parental vaccination status and child vaccination status. Only children under 5 years were more likely to be vaccinated against COVID-19 if their parent was a health care worker.

Ukrainian scientific and practical conference with master classes «New foreign clinical guidelines in the practice of internal medicine»

Ukrainian scientific and practical conference with master classes «New foreign clinical guidelinesin the practice of internal medicine»Dedicated to the 95th anniversary of Department of Propaedeutics of Internal Medicine No.1 BogomoletsNational Medical UniversityKyiv, May 14-15, 2024

Communication quality predicts patients’ colorectal cancer screening behavior

The purpose of the present study was to investigate the quality of patient/clinician communication as one potential factor that impacts colorectal cancer screening behavior. As part of a larger randomized controlled trial conducted between 2011 and 2016 in the setting of community and academic family medicine or internal medicine practices in Michigan, USA, patients completed a pre-encounter survey, completed their regularly scheduled visit with their primary care clinician (which was audio-recorded), completed a post-encounter survey, and allowed 6-month follow-up chart audit. We trained 10 coders to rate 216 of the audio-recorded conversations between 216 patients and their primary care physicians for 6 specific features of communication quality (using 7-point scales), including the extent to which participants enacted attention to medical content, engagement, emotional expression, relationships, face, and accommodation. At least 3 coders rated each conversation, and intraclass correlations (i.e., reliability assessment) were in the good to excellent range. We found that patient and clinician attention to face (an identity goal) was a significant predictor of colorectal cancer screening at 6 months follow up. Measuring communication in terms of attention to multiple goals reveals unexpected findings about the aspects of communication that impact colorectal cancer screening behavior. The focus of many interventions to improve colorectal cancer screening rates is on the content (i.e., task goals) of clinicians' communication (such as presenting the different options for screening), yet the content of communication was not a significant predictor of screening in the present study. Rather, clinicians' and patients’ attention to identity goals predicted screening behavior, which suggests that interventions may not need to be overly complex and that simply improving the quality of attention to identity goals in clinician communication might be one of the most straightforward yet impactful ways to improve colorectal cancer screening uptake among patients.

Factors associated with medical students’ career choice in different specialties: a multiple cross-sectional questionnaire study at a German medical school

BackgroundGiven the shortage and unequal distribution of physicians across specialties, we aimed to evaluate factors associated with medical students’ career choices, including background, personality traits, educational experience, personal interests, lifestyle considerations, and the awareness of work requirements.MethodsWe conducted multiple cross-sectional surveys of students; a 159-item online questionnaire was designed and students from three different stages of the six-year medical degree course (outset, clinical phase, and on graduation) were invited to complete the survey. Data were collected between May 2021 and April 2023.ResultsThe questionnaire was sent to 1406 students, of whom 683 replied (49%); 481 respondents were female (70%). The top specialty choices across the respondents were internal medicine, surgery, and general practice, with anaesthesiology, paediatric and adolescent medicine (ranging 11–15%), and obstetrics and gynaecology also receiving interest, with 6% undecided. In particular, female students lost interest in surgery during the course of study in favour of the other options. The choice of general practice was associated with more vocational training, prior positive experiences with the specialty, and lower grades in the university entry examination. Clinical clerkships in a specific (freely chosen) specialty aligned with career choice, while the final practical year did not have an impact on career decision-making. All students highly desired regulated working hours and work-life-balance; however, students choosing surgery rated these items as less important. Willingness to work in a hospital environment was highly associated with choosing anaesthesiology and surgery, whereas rural areas and practices were associated with general practice. Higher scores at agreeableness were associated with choosing paediatric and adolescent medicine by more female students, whereas lower neuroticism values were associated with the choice of anaesthesiology.ConclusionsThe results highlight the intricate nature of decision-making and shed light on various aspects that contribute to the process of selecting a specialty. By identifying and addressing influencing factors, we can develop targeted interventions and policies to enhance diversity and distribution across medical specialisations and to aim for high-quality and equitable healthcare that matches the specific needs of both individuals and the population as a whole.Graphical

Large Language Model–Based Responses to Patients’ In-Basket Messages

Virtual patient-physician communications have increased since 2020 and negatively impacted primary care physician (PCP) well-being. Generative artificial intelligence (GenAI) drafts of patient messages could potentially reduce health care professional (HCP) workload and improve communication quality, but only if the drafts are considered useful. To assess PCPs' perceptions of GenAI drafts and to examine linguistic characteristics associated with equity and perceived empathy. This cross-sectional quality improvement study tested the hypothesis that PCPs' ratings of GenAI drafts (created using the electronic health record [EHR] standard prompts) would be equivalent to HCP-generated responses on 3 dimensions. The study was conducted at NYU Langone Health using private patient-HCP communications at 3 internal medicine practices piloting GenAI. Randomly assigned patient messages coupled with either an HCP message or the draft GenAI response. PCPs rated responses' information content quality (eg, relevance), using a Likert scale, communication quality (eg, verbosity), using a Likert scale, and whether they would use the draft or start anew (usable vs unusable). Branching logic further probed for empathy, personalization, and professionalism of responses. Computational linguistics methods assessed content differences in HCP vs GenAI responses, focusing on equity and empathy. A total of 16 PCPs (8 [50.0%] female) reviewed 344 messages (175 GenAI drafted; 169 HCP drafted). Both GenAI and HCP responses were rated favorably. GenAI responses were rated higher for communication style than HCP responses (mean [SD], 3.70 [1.15] vs 3.38 [1.20]; P = .01, U = 12 568.5) but were similar to HCPs on information content (mean [SD], 3.53 [1.26] vs 3.41 [1.27]; P = .37; U = 13 981.0) and usable draft proportion (mean [SD], 0.69 [0.48] vs 0.65 [0.47], P = .49, t = -0.6842). Usable GenAI responses were considered more empathetic than usable HCP responses (32 of 86 [37.2%] vs 13 of 79 [16.5%]; difference, 125.5%), possibly attributable to more subjective (mean [SD], 0.54 [0.16] vs 0.31 [0.23]; P < .001; difference, 74.2%) and positive (mean [SD] polarity, 0.21 [0.14] vs 0.13 [0.25]; P = .02; difference, 61.5%) language; they were also numerically longer (mean [SD] word count, 90.5 [32.0] vs 65.4 [62.6]; difference, 38.4%), but the difference was not statistically significant (P = .07) and more linguistically complex (mean [SD] score, 125.2 [47.8] vs 95.4 [58.8]; P = .002; difference, 31.2%). In this cross-sectional study of PCP perceptions of an EHR-integrated GenAI chatbot, GenAI was found to communicate information better and with more empathy than HCPs, highlighting its potential to enhance patient-HCP communication. However, GenAI drafts were less readable than HCPs', a significant concern for patients with low health or English literacy.

Nursing Students' and Nurse Preceptors' Perspectives of an Ambulatory Dedicated Education Unit in Primary Care and General Internal Medicine.

The sustainability of prelicensure nursing clinical learning models within ambulatory care is dependent on strong partnership and the availability of ambulatory nurse preceptors. Evaluation of preceptor and student satisfaction with ambulatory clinical experiences is necessary to identify program strengths and opportunities. Nursing students' and nurse preceptors' perceptions of an ambulatory dedicated education unit (DEU) in primary care and general internal medicine practices were measured from 2021 to 2023. Students' survey responses indicated a high level of agreement for 20 (90.9%) of 22 items in 2021, 35 (100%) of 35 items in 2022, and 32 (91.4%) of 35 items in 2023. Preceptor responses demonstrated favorable agreement with all of the work-life satisfaction across the 3 years of the survey, with the exception of one question on the 2021 survey. Nursing students and staff nurse preceptors found the ambulatory DEU teaching and learning experience to be positive and satisfying. [J Nurs Educ. 2024;63(3):171-177.].

Selected novelties for hospital based internal medicine

In this selective overview of articles, we describe new concepts, therapeutic measures and pharmacological agents that may modify current practice in clinical internal medicine. Novelties for the management of cardiovascular disease, such as heart failure, hypoxemic respiratory failure, nosocomial pneumonia and certain allergies are discussed.

Meta-analytic analysis of the role of hemostatic evaluation in optimizing surgical results

Introduction: Pre-surgical clinical assessment constitutes an essential practice in internal medicine, focused on the identification of risk factors to reduce perioperative morbidity and mortality.Objective: This study seeks to critically evaluate the effectiveness of preoperative coagulation tests to predict bleeding complications in elective non-cardiac surgeries, in order to validate their clinical relevance and adjust practices to real needs based on solid evidence.Method: A meta-analysis approach was employed to synthesize data from multiple studies examining the correlation between preoperative coagulation testing and intra- and postoperative bleeding complications. Study selection was based on rigorous criteria to include only those with patients without a history of hematological diseases who underwent elective non-cardiac surgeries.Results: The results indicate that alterations in coagulation tests are not significantly associated with an increased risk of hemorrhagic complications, as evidenced by a relative risk (RR) of less than one. This suggests that routine performance of these tests in the study population may not be necessary and does not contribute significantly to the safety of the surgical patient.Conclusions: The study supports a review of clinical guidelines to reduce unnecessary defensive medical practices and encourage evidence-based decisions. It is recommended to limit preoperative coagulation testing to patients with identifiable risk factors or clinical manifestations of hemostatic disorders, avoiding widespread and unsubstantiated procedures that overload health systems without improving clinical outcomes.

Meta-analytic analysis of the role of hemostatic evaluation in optimizing surgical results

Introduction: pre-surgical clinical assessment constitutes an essential practice in internal medicine, focused on the identification of risk factors to reduce perioperative morbidity and mortality.Objective: this study seeks to critically evaluate the effectiveness of preoperative coagulation tests to predict bleeding complications in elective non-cardiac surgeries, in order to validate their clinical relevance and adjust practices to real needs based on solid evidence.Method: a meta-analysis approach was employed to synthesize data from multiple studies examining the correlation between preoperative coagulation testing and intra- and postoperative bleeding complications. Study selection was based on rigorous criteria to include only those with patients without a history of hematological diseases who underwent elective non-cardiac surgeries.Results: the results indicate that alterations in coagulation tests are not significantly associated with an increased risk of hemorrhagic complications, as evidenced by a relative risk (RR) of less than one. This suggests that routine performance of these tests in the study population may not be necessary and does not contribute significantly to the safety of the surgical patient.Conclusions: the study supports a review of clinical guidelines to reduce unnecessary defensive medical practices and encourage evidence-based decisions. It is recommended to limit preoperative coagulation testing to patients with identifiable risk factors or clinical manifestations of hemostatic disorders, avoiding widespread and unsubstantiated procedures that overload health systems without improving clinical outcomes

Prescribing by Physician Associates and Nurse Practitioners in Older Adults Is Outpacing Traditional Prescribers: Implications for Practice in American Medicine.

Prescribing is a significant activity undertaken by physicians, physician associates/assistants (PAs), and nurse practitioners (NPs). We analyzed prescribing data to understand better the growing presence of PAs and NPs in older adults. A trend in frequently prescribed medications was compared with other physicians. All prescriptions in Medicare Part D were grouped into broad categories of drugs and linked to each type of provider. The analysis spanned 9 years (2013-2021). The results revealed that all five providers similarly prescribed the top three main drug classes (antacids, antihypertensives, and statins). In addition, there was a decline in the number of unique prescribers and prescriptions for all three types of physicians (family medicine, internal medicine, and general practice physicians). Concurrently, the number and share of prescriptions for NPs and PAs increased yearly. The findings are consistent with data that PAs and NPs are backfilling physician shortages in treating older adults.

Advancements in Cardiovascular Risk Assessment: Integrating New Tools and Guidelines in Internal Medicine Practice

Advancements in Cardiovascular Risk Assessment: Integrating New Tools and Guidelines in Internal Medicine Practice

Legal integration of artificial intelligence into internal medicine : Data protection, regulatory, reimbursement and liability questions

Artificial intelligence (AI) opens up new opportunities to improve medical care in internal medicine; however, legal uncertainties in the application of AI impede its integration into the daily practice of internal medicine. To clarify the situation this paper gives an overview of the legal aspects related to AI and shows which frameworks must be adhered to in order to exploit the benefits of AI without neglecting the rights and protection of patients. The paper first addresses data protection issues which arise when sensitive health data are processed by AI. This is followed by adiscussion of the key regulatory requirements for the use of AI in internal medicine. As the establishment of AI in practice also depends on sufficient funding, legal issues of reimbursement are additionally examined. Finally, the specific features that need to be considered when using AI to avoid medical liability consequences are highlighted.

S1533 Assessing Knowledge and Management of NAFLD Amongst Residents in an Internal Medicine Practice

S1533 Assessing Knowledge and Management of NAFLD Amongst Residents in an Internal Medicine Practice

News from the European Journal of Therapeutics: A new issue and a new editorial board

News from the European Journal of Therapeutics: A new issue and a new editorial board

How much POCUS for Czech internists?

The introduction of point-of-care ultrasonography into practice in internal medicine and subsequently into the educational program for our specialty brought the need to define a curriculum for training in this method. We solve the question of "what to teach" - i.e. what core ultrasound competencies internists should learn for their practice. It is also necessary to define the procedure "how to teach" - the form and content of the education program, what the basic course should contain, and above all how the subsequent training should take place in practice. The third major problem to be solved is "who should teach", i.e. the definition of the requirements for trainers who will lead the training.

916-P: The Demographic Variables Associated with Diabetes Technology Knowledge or Use in Adults with Type 2 Diabetes

Background: Studies in populations with type 1 diabetes highlight the racial-ethnic disparities in the use of diabetes technology. Our project aims to investigate racial-ethnic and socioeconomic disparities in diabetes technology knowledge and use in adult patients with type 2 diabetes (T2D) in ambulatory setting. Method: We recruited adults aged 40 and older with T2D who visited one of four internal medicine practices between July 1, 2018 and June 30, 2021. We selected patients in the electronic record who use insulin, have English as a primary language, and have an email address. Eligible participants were invited to participate via an email link to a REDCap questionnaire. All variables were summarized descriptively using frequencies and percentages, and were compared across groups using Pearson’s Chi-Square Test or Fisher’s Exact Test. Results: We included 116 patients in the analysis, most of whom were white (62%), elderly Medicare recipients. Those who are of racial-ethnic minoritized groups are less likely to have knowledge of CGM (p = 0.013) or insulin pumps (p = 0.001). Patients who have high school education or less have less awareness of insulin pumps (p = 0.041). Interestingly, neither awareness nor use of CGM or insulin pump were found to be associated with income. Conclusion: This cross-sectional analysis suggests that racial-ethnic minoritized groups or those with lower education have lower knowledge of CGM or insulin pumps and this disparity cannot be explained by differences in socioeconomic status. Providers need to be aware of their potential implicit biases in relation to education and prescription of diabetes technology. Disclosure Y.Ye: None. B.A.Acevedo-mendez: None. S.Izard: None. A.K.Myers: Research Support; Neurocrine Biosciences, Inc.