Annals of Family Medicine最新文献

Background: There is considerable inconsistency regarding study results on the association of dietary glycemic index (GI) and glycemic load (GL) with lung cancer risk. We aimed to investigate this relation in the US National Cancer Institute's Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial cohort.

Methods: Baseline characteristics were collected with the baseline questionnaire, and diet was assessed with the diet history questionnaire. All incident lung cancer cases were verified via pathology. We estimated hazard ratios (HRs) and 95% CIs for lung cancer risk associated with GI and GL by Cox regression modeling.

Results: During a median follow-up of 12.2 years (1,213,533 person-years), a total of 1,706 incident lung cancer events occurred including 1,473 (86.3%) cases of non-small cell lung cancer (NSCLC) and 233 (13.7%) of small cell lung cancer (SCLC). After multivariate adjustment, GI was positively associated with lung cancer (4th quartile [Q4] vs 1st quartile [Q1]; HR 1.13; 95% CI, 1.05-1.31), NSCLC (Q4 vs Q1; HR 1.11; 95% CI, 1.05-1.29), and SCLC (Q4 vs Q1; HR 1.34; 95% CI, 1.02-2.27). Conversely, we found an association between dietary GL and a decreased risk of lung cancer (Q4 vs Q1; HR 0.72; 95% CI, 0.57-0.90) and NSCLC (Q4 vs Q1; HR 0.68; 95% CI, 0.53-0.87) but not SCLC (Q4 vs Q1; HR 0.90; 95% CI, 0.51-1.58). These results were consistently observed across subgroup analyses.

Conclusions: These findings show that high dietary GI is associated with an increased risk of lung cancer, NSCLC, and SCLC, whereas GL is inversely associated with the risk of lung cancer and NSCLC.

My daughter has been diagnosed with a range of chronic conditions, including Hyper-mobile Ehlers-Danlos Syndrome and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). I have approached my role as caregiver in the same way I approach my day job leading social science research: reading the literature, carefully observing her condition, and developing hypotheses about her conditions and how they might be treated. I now have more than 7 years of longitudinal observation-a wealth of data-but no easy way to share with the medical research community the hypotheses these observations have engendered and my ideas about how to productively structure future research to accelerate progress toward treatments for her and others like her. In this essay, I share my thoughts on why patient and caregiver observations and hypotheses are important and how the medical research field might tap into them to make faster progress toward effective treatments for complex medical conditions.

Purpose: Mutual trust is a critical component of the physician-patient relationship, and although much research has examined patient trust in the physician, little attention has been given to the physician's trust in the patient in the general practice setting. This study explored general practitioners' (GPs') understanding of trust in their patients.

Methods: We conducted a qualitative study using semistructured telephone interviews with a convenience sample of Australian GPs mostly from metropolitan New South Wales, focused on how the GPs understood trust in their patients, how such trust developed, and its implications for medical care. Interviews were audio recorded, transcribed verbatim, verified, and de-identified before thematic analysis.

Results: Qualitative analysis was based on interviews with 25 GPs. We identified 3 main themes pertaining to GPs' trust in their patients: (1) trusting patients is an assumed starting point, (2) trust in patients then deepens and develops over time as part of a mutual trusting therapeutic relationship, and (3) trust in their patients is challenged when patients are perceived to be manipulating the relationship for secondary gain.

Conclusions: Our study shows that GPs understand a therapeutic relationship with a patient begins by trusting what their patients say, then develops as their patients become more actively involved in their own management. GPs need support in building mutually trusting relationships, especially in patients with complex care needs.

In this perspective piece, I explore an incredibly challenging year of my life: the year I lost joy in medicine. It was unexpected, yet not unsurprising, for me to feel this way given the seismic changes that occurred in my department: multiple leadership transitions, a pandemic, and significant faculty attrition. I wanted my clinical work to be enough to sustain me when I had lost academic mentorship and sponsorship, but the dysfunctional environment leached the joy out of my work and caused me to contemplate leaving my institution and leaving medicine altogether. Ultimately, several changes occurred that caused me to remain at my institution and helped me to regain my joy in the practice of medicine. My experience informed my understanding that small but significant shifts in compensation, schedules, and administrative work can help retain physicians. As we contemplate a shortage of physicians, institutions need to focus on acknowledging physicians for our work and rebuilding joy into our careers.

Home Health Focus is a new publicly available data set representing home health utilization by Medicare beneficiaries, aggregated annually at the home health agency, county, and state levels from 2016 to 2019. This data can be used by anyone interested in trends of Medicare home health users, both locally and nationally. We describe the creation of the cohorts of home health users, including over 6 million home health stays from 5 million Medicare beneficiaries. We also provide examples of potential research questions using these data sets.