Annals of Family Medicine最新文献

Purpose: Alcohol use during pregnancy can cause miscarriage, stillbirth, and fetal alcohol spectrum disorders. Despite no safe level of alcohol consumption during pregnancy, 13.5% of pregnant adults reported drinking, and 5.2% reported binge drinking during 2018-2020. This study aimed to improve alcohol screening and brief intervention (ASBI) practices in primary care settings using the Office Champions Quality Improvement Model.

Methods: Seventeen family medicine practices participated. Champions led system-level changes, including workflow redesign, staff training, and electronic health record modifications. Chart reviews were conducted at 3 stages (ie, baseline, post-intervention, and sustainability) to assess change in ASBI efforts. A sustainability survey assessed likelihood of continued ASBI efforts after study completion.

Results: A total of 2,725 chart reviews were completed. For the first 2 stages 17 practices submitted data, and 14 practices completed the third stage. Alcohol use screening rate increased from 61% to 81% (P <.001) and intervention rates increased from 22% to 67% (P <.001). Identification of pregnancy intention increased from 3% to 66% (P <.001) and use of the Alcohol Use Disorders Identification Test-Consumption tool increased from 3% to 48% (P <.001). Most interventions involved brief counseling and goal setting. Nineteen individual respondents completed the sustainability survey, and most reported confidence in continuing ASBI efforts.

Conclusion: The Office Champions Quality Improvement Model enhanced ASBI implementation in primary care settings. System-level integration, validated screening tools, education, and a team-based approach supported improvements in ASBI.

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.