New research and findings from open-access journals and the U.S. research agencies.
This cohort study examines the association of Alzheimer disease biomarkers with postoperative delirium in older adults undergoing elective cardiac surgery.
This systematic review estimates the direct-purchase-equivalent drug acquisition costs associated with federally sponsored cancer clinical trials.
This scoping review of randomized clinical trials using hierarchical composite end points examines characteristics of their use, including how they are constructed, analyzed, and reported.
This cohort study examines early childhood education and care attendance and developmental vulnerability at school entry.
BACKGROUND In Singapore, cervical cancer screening rates remain suboptimal, with only clinician sampling included in the national screening program. Self-sampling human papillomavirus (HPV) DNA testing might overcome barriers to clinician-based screening and improve uptake. We assessed the effect of offering self-sampling alongside clinician sampling on screening uptake and high-risk HPV detection compared with clinician sampling alone. METHODS This pragmatic, 2-arm randomized controlled trial with Zelen design was conducted across NHG Polyclinics, NHG Health in Singapore. Women aged 30-69…
PURPOSE Social prescribing is a promising strategy to address unmet health and social needs and reduce health disparities. We compared 2 social prescribing approaches that differed with respect to their level of navigation support. METHODS We conducted a randomized controlled trial among patients with health and/or social needs in primary care practices in 2 regions of Ontario, Canada. Patients were randomized to an Access to Resources in the Community (ARC) intervention arm or a 211-Ontario control arm. ARC patients were offered comprehensive, longitudinal navigation services that included…
PURPOSE Self-care is central to managing cardiometabolic multimorbidity, yet primary care clinicians have limited insight into how patients navigate self-care decisions in daily life. This study explored self-care decision-making contexts, processes, and patterns among patients with cardiometabolic multimorbidity to inform family medicine practice. METHODS We conducted a qualitative cohort study guided by naturalistic decision-making theory among 27 adults with cardiometabolic multimorbidity (mean age = 62.7 years; 16 men). Participants were purposively sampled from a tertiary hospital and a…
PURPOSE Continuity of care has been associated with lower health care use and costs. When general practitioners (GPs) serve as gatekeepers to hospital care, having an ongoing relationship with a GP may promote more efficient care and reduce urgent referrals, thereby lowering costs. We examined the association of 2 conceptually distinct measures of continuity in general practice with both urgent hospital admissions and hospital costs. METHODS We conducted a retrospective cohort study using routinely collected health care data from 100,450 adults in 48 Dutch general practices (2013-2018) who…
PURPOSE Health system ownership of physician practices has grown rapidly, yet little is known about how health system structures and processes affect primary care physicians’ day-to-day experiences while delivering care. We aimed to examine how practice ownership influences physician experiences with autonomy, care coordination, infrastructure, and patient relationships in health system–owned versus independent primary care practices. METHODS Qualitative study using semistructured interviews were conducted from March through May 2024 with 30 primary care physicians: 15 employed by health…
PURPOSE The rapid expansion of medical information highlights the importance of physicians being trained in self-directed learning (SDL) so that they can adapt their practice to incorporate current evidence. The Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education highlight SDL as a key training outcome, but residency program integration of this training is not clear. We explored perceptions of directors of family medicine residency programs about their programs’ readiness to teach and assess SDL skills. METHODS In 2024, we surveyed all US family…
PURPOSE Widespread change toward transactional and technological health care is contrary to the generalist philosophy and is challenging the ability of family medicine physicians to enact its values and meet patient needs. This research seeks to build understanding of generalism by asking international generalist physicians to reflect on the often tacit features of generalism that provide much of its value. METHODS Researchers conducted a 2-phase qualitative study. Phase 1 consisted of Zoom (Zoom Video Communications, Inc) individual interviews with 13 international generalist physicians and…
PURPOSE Social care—health care that aims to understand and address patients’ social needs—is increasingly recognized as a strategy for reducing disparities. However, social care literature is characterized by numerous conflicts. Paradox, the coexistence of seemingly contradictory yet simultaneously true positions, can serve as a useful lens for examining these tensions. This study aimed to identify key paradoxes in the social care literature to illuminate the resources, mindset, and approaches required for effective social care. METHODS A sub-analysis was conducted of a systematic review on…
Family physicians are well-positioned to support both persons living with dementia (PLWD) and their caregivers. However, current electronic medical record (EMR) systems do not capture the relational and interdependent nature of dementia care. Dyadic data, linking the records of persons living with dementia (PLWD) and their caregivers, could support more integrated, proactive, and personalized care. While there is growing interest in leveraging EMRs for this purpose, few systems enable routine dyadic linkage, limiting clinical utility and research capacity. This report describes the current…
The struggles faced by individuals and families affected by autism can vary tremendously. This, in turn, means that each family’s reality is quite different. The extreme differences in the experiences faced can lead to different needs and different perceptions of autism. In this essay, a physician shares her experiences as a pediatric physician and a mother of a child with autism, and describes a dichotomy of experiences noted within the autism community. As medical professionals, we must understand the differences in perceptions and experiences to properly care for patients with autism and…
I came to the United States as a refugee at age eleven, fleeing religious persecution in Iran. Decades later, as a family physician, I found myself caring for newly arrived refugees during the Afghan humanitarian crisis of 2021. Launching and leading a refugee clinic forced a convergence of my personal history and professional identity that I had long avoided. Each patient encounter echoed my own experiences of displacement, fear, and hope, transforming clinical care into an act of witnessing, healing, and shared humanity. Through caring for refugees, I confronted unresolved trauma, discovered…
Ménière’s disease, a chronic disorder of the inner ear, has brought one physician a great deal of both suffering and insight. A variety of treatment options, including dietary changes and medications, have failed to help. However, the physician has found relief from a number of unexpected sources, including meditation, his social support network, and even his six-year-old child. The lessons he has learned have made him a more knowledgeable and empathetic physician. Abstract available in عربي ( Arabic ); Deutsch ( German ); Español ( Spanish ); Francais ( French ); हिन्ी ( Hindi )…
As obstetric services disappear from rural communities, family physicians are increasingly asked whether operative maternity care remains part of their role. This reflection argues that maintaining cesarean delivery capacity is not an expansion of scope, but a commitment to continuity and to remaining present for patients at moments of greatest vulnerability. Drawing on rural clinical experience, this essay explores how trust, built over time, extends into the operating room, where continuity takes on a different but no less essential form. It also considers the ethical implications of…