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Search Results for "american academy"
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Displaying 1 - 1 of 1 in Online Learning Center
Trauma-Informed Care Part 1
Trauma has an undeniable impact on our patients' health and illness, and resilience is vital to their ability to buffer that trauma. The DEI Shift welcomes Dr. Moira Szilagyi, President of the American Academy of Pediatrics, and Dr.
Displaying 1 - 10 of 1179 in Policy Library
Displaying 1 - 10 of 28 in Performance Measures
Tuberculosis (TB) Prevention for Patients with Psoriasis, Psoriatic Arthritis, and Rheumatoid Arthritis Patients on a Biological Immune Response Modifier
Percentage of patients whose providers are ensuring active tuberculosis prevention either through yearly negative standard tuberculosis screening tests or are reviewing the patient’s history to determine if they have had appropriate management for a recent or prior positive test.
Stroke and Stroke Rehabilitation: Screening for Dysphagia
INACTIVE REVIEW: This measure review is older than five years. Percentage of patients aged 18 years and older with a diagnosis of ischemic stroke or intracranial hemorrhage who receive any food, fluids or medication by mouth (PO) for whom a dysphagia screening was performed prior to PO intake in accordance with a dysphagia screening tool approved by the institution in which the patient is receiving care
Stroke and Stroke Rehabilitation: Rehabilitation Services Ordered
INACTIVE REVIEW: This measure review is older than five years. Percentage of patients aged 18 years and older with a diagnosis of ischemic stroke or intracranial hemorrhage for whom occupational, physical, or speech rehabilitation services were ordered at or prior to inpatient discharge OR documentation that no rehabilitation services are indicated at or prior to inpatient discharge
Stroke and Stroke Rehabilitation: Discharged on Antithrombotic Therapy
Percentage of patients aged 18 years and older with a diagnosis of ischemic stroke or transient ischemic attack (TIA) who were prescribed antithrombotic therapy at discharge.
Stroke and Stroke Rehabilitation: Deep Vein Thrombosis (DVT) Prophylaxis for Ischemic Stroke or Intracranial Hemorrhage
INACTIVE REVIEW: This measure review is older than five years. Percentage of patients aged 18 years and older with a diagnosis of ischemic stroke or intracranial hemorrhage who were administered DVT prophylaxis by the end of hospital day two
Stroke and Stroke Rehabilitation: Anticoagulant Therapy Prescribed for Atrial Fibrillation at Discharge
INACTIVE REVIEW: This measure review is older than five years. Percentage of patients aged 18 years and older with a diagnosis of ischemic stroke or transient ischemic attack (TIA) with documented permanent, persistent, or paroxysmal atrial fibrillation who were prescribed an anticoagulant at discharge
Sleep Apnea: Severity Assessment at Initial Diagnosis
Percentage of patients aged 18 years and older with a diagnosis of obstructive sleep apnea who had an apnea hypopnea index (AHI) or a respiratory disturbance index (RDI) measured at the time of initial diagnosis.
Sleep Apnea: Positive Airway Pressure Therapy Prescribed
INACTIVE REVIEW: This measure review is older than five years. Patients who were prescribed positive airway pressure therapy as a proportion of all patients aged 18 years and older with a diagnosis of moderate or severe obstructive sleep apnea
Sleep Apnea: Assessment of Sleep Symptoms
Percentage of visits for patients aged 18 years and older with a diagnosis of obstructive sleep apnea that includes documentation of an assessment of sleep symptoms, including presence or absence of snoring and daytime sleepiness.
Sleep Apnea: Assessment of Adherence to Positive Airway Pressure Therapy
Percentage of visits for patients aged 18 years and older with a diagnosis of obstructive sleep apnea who were prescribed positive airway pressure therapy who had documentation that adherence to positive airway pressure therapy was objectively measured.
Displaying 1 - 10 of 1285 in Annals of Internal Medicine
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Nonpharmacologic and Pharmacologic Management of Acute Pain From Non–Low Back, Musculoskeletal Injuries in Adults: A Clinical Guideline From the American College of Physicians and American Academy of Family Physicians
Description: The American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) developed this guideline to provide clinical recommendations on nonpharmacologic and pharmacologic management of acute pain from non–low back, musculoskeletal injuries in adults in the outpatient setting. The guidance is based on current best available evidence about benefits and harms, taken in the context of costs and patient values and preferences. This guideline does not address noninvasive treatment of low back pain, which is covered by a separate ACP guideline that has also been endorsed by AAFP. Methods: This guideline is based on a systematic evidence review on the comparative efficacy and safety of nonpharmacologic and pharmacologic management of acute pain from non–low back, musculoskeletal injuries in adults in the outpatient setting and a systematic review on the predictors of prolonged opioid use. We evaluated the following clinical outcomes using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system: pain (at ≤2 hours and at 1 to 7 days), physical function, symptom relief, treatment satisfaction, and adverse events. Target Audience and Patient Population: The target audience is all clinicians, and the target patient population is adults with acute pain from non–low back, musculoskeletal injuries. Recommendation 1: ACP and AAFP recommend that clinicians treat patients with acute pain from non–low back, musculoskeletal injuries with topical nonsteroidal anti-inflammatory drugs (NSAIDs) with or without menthol gel as first-line therapy to reduce or relieve symptoms, including pain; improve physical function; and improve the patient's treatment satisfaction (Grade: strong recommendation; moderate-certainty evidence). Recommendation 2a: ACP and AAFP suggest that clinicians treat patients with acute pain from non–low back, musculoskeletal injuries with oral NSAIDs to reduce or relieve symptoms, including pain, and to improve physical function, or with oral acetaminophen to reduce pain (Grade: conditional recommendation; moderate-certainty evidence). Recommendation 2b: ACP and AAFP suggest that clinicians treat patients with acute pain from non–low back, musculoskeletal injuries with specific acupressure to reduce pain and improve physical function, or with transcutaneous electrical nerve stimulation to reduce pain (Grade: conditional recommendation; low-certainty evidence). Recommendation 3: ACP and AAFP suggest against clinicians treating patients with acute pain from non–low back, musculoskeletal injuries with opioids, including tramadol (Grade: conditional recommendation; low-certainty evidence).
How Would You Manage This Patient With Chronic Insomnia?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center: Annals of Internal Medicine: Vol 175, No 12
Insomnia, which is characterized by persistent sleep difficulties in association with daytime dysfunction, is a common concern in clinical practice. Chronic insomnia disorder is defined as symptoms that occur at least 3 times per week and persist for at least 3 months. The American Academy of Sleep Medicine (AASM) published recent guidelines on behavioral and psychological treatment as well as pharmacologic therapy for chronic insomnia disorder. Regarding behavioral and psychological approaches, the only intervention strongly recommended was multicomponent cognitive behavioral therapy for insomnia. Regarding pharmacologic treatment, the AASM, based on weak evidence, suggested a limited number of medications that might be useful and others that probably are not. Here, 2 clinicians with expertise in sleep disorders—one a clinical psychologist and the other a physician—debate the management of a patient with chronic insomnia who has been treated with medications. They discuss the role of behavioral and psychological interventions and pharmacologic therapy for chronic insomnia and how the primary care practitioner should approach such a patient.
Hydroxychloroquine Dose and Risk for Incident Retinopathy: A Cohort Study: Annals of Internal Medicine: Vol 176, No 2
Background: Hydroxychloroquine is recommended for all patients with systemic lupus erythematosus and is often used for other inflammatory conditions, but a critical long-term adverse effect is vision-threatening retinopathy. Objective: To characterize the long-term risk for incident hydroxychloroquine retinopathy and examine the degree to which average hydroxychloroquine dose within the first 5 years of treatment predicts this risk. Design: Cohort study. Setting: U.S. integrated health network. Participants: All patients aged 18 years or older who received hydroxychloroquine for 5 or more years between 2004 and 2020 and had guideline-recommended serial retinopathy screening. Measurements: Hydroxychloroquine dose was assessed from pharmacy dispensing records. Incident hydroxychloroquine retinopathy was assessed by central adjudication of spectral domain optical coherence tomography with severity assessment (mild, moderate, or severe). Risk for hydroxychloroquine retinopathy was estimated over 15 years of use according to hydroxychloroquine weight-based dose (>6, 5 to 6, or ≤5 mg/kg per day) using the Kaplan–Meier estimator. Results: Among 3325 patients in the primary study population, 81 developed hydroxychloroquine retinopathy (56 mild, 17 moderate, and 8 severe), with overall cumulative incidences of 2.5% and 8.6% at 10 and 15 years, respectively. The cumulative incidences of retinopathy at 15 years were 21.6% for higher than 6 mg/kg per day, 11.4% for 5 to 6 mg/kg per day, and 2.7% for 5 mg/kg per day or lower. The corresponding risks for moderate to severe retinopathy at 15 years were 5.9%, 2.4%, and 1.1%, respectively. Limitation: Possible misclassifications of dose due to nonadherence to filled prescriptions. Conclusion: In this large, contemporary cohort with active surveillance retinopathy screening, the overall risk for hydroxychloroquine retinopathy was 8.6% after 15 years, and most cases were mild. Higher hydroxychloroquine dose was associated with progressively greater risk for incident retinopathy. Primary Funding Source: National Institutes of Health.
A Framework for the Development of Living Practice Guidelines in Health Care
Background: Living practice guidelines are increasingly being used to ensure that recommendations are responsive to rapidly emerging evidence. Objective: To develop a framework that characterizes the processes of development of living practice guidelines in health care. Design: First, 3 background reviews were conducted: a scoping review of methods papers, a review of handbooks of guideline-producing organizations, and an analytic review of selected living practice guidelines. Second, the core team drafted the first version of the framework. Finally, the core team refined the framework through an online survey and online discussions with a multidisciplinary international group of stakeholders. Setting: International. Participants: Multidisciplinary group of 51 persons who have experience with guidelines. Measurements: Not applicable. Results: A major principle of the framework is that the unit of update in a living guideline is the individual recommendation. In addition to providing definitions, the framework addresses several processes. The planning process should address the organization's adoption of the living methodology as well as each specific guideline project. The production process consists of initiation, maintenance, and retirement phases. The reporting should cover the evidence surveillance time stamp, the outcome of reassessment of the body of evidence (when applicable), and the outcome of revisiting a recommendation (when applicable). The dissemination process may necessitate the use of different venues, including one for formal publication. Limitation: This study does not provide detailed or practical guidance for how the described concepts would be best implemented. Conclusion: The framework will help guideline developers in planning, producing, reporting, and disseminating living guideline projects. It will also help research methodologists study the processes of living guidelines. Primary Funding Source: None.
Displaying 1 - 10 of 15 in Annals of Internal Medicine: Clinical Cases
Physical Examination Manifestations of Aortic Insufficiency | Annals of Internal Medicine: Clinical Cases
The eponyms of aortic regurgitation are well recognized, yet their diagnostic accuracy remains poor. Nevertheless, they remain part of the medical nomenclature, highlight the importance of the physical examination, and provide a historical lens to a disease in the age before more modern technology.
Persistent Hypoxemia on Home Sleep Apnea Testing Prompting Further Evaluation for Pulmonary Embolism: A Case Report | Annals of Internal Medicine: Clinical Cases
Obstructive sleep apnea is a condition characterized by recurrent upper airway collapse during sleep, which may be associated with sleep disruption and repetitive oxygen desaturations. It is diagnosed by nocturnal in-lab polysomnography or home sleep apnea testing. We present a case of an otherwise healthy individual who had home sleep apnea testing that revealed persistent, unexplained hypoxemia which, on further investigation, was found to be due to a saddle pulmonary embolism.
Nocturnal Enuresis in an Adult With Obesity | Annals of Internal Medicine: Clinical Cases
We present a case of nocturnal enuresis (NE) in an adult with obesity that resolved with treatment of obstructive sleep apnea (OSA). The patient reported daytime somnolence and enuresis with no daytime urinary incontinence. A home sleep study diagnosed OSA. The patient received continuous positive airway pressure (CPAP) treatment with immediate resolution of enuresis. This case highlights the importance of recognizing enuresis as a potential symptom of sleep apnea.
Clinical Challenges in Tension Gastrothorax: A Tale of Two Cases and Review of the Literature | Annals of Internal Medicine: Clinical Cases
Tension gastrothorax is a life-threatening condition characterized by herniation of the stomach into the thoracic cavity, leading to a mediastinal shift, causing obstructive shock. It can be frequently misdiagnosed as tension pneumothorax due to similar presentations. Prompt recognition is crucial to reduce associated morbidity and mortality. We present 2 adult cases of acute hypoxemic respiratory failure that progressed to tension gastrothorax with the use of noninvasive positive-pressure ventilation. Emergent management involves decompression strategies with nasogastric tube placement, but definitive management requires surgical correction. These cases underscore the importance of early diagnosis and appropriate management to improve patient outcomes.
A Case of Lamotrigine-Induced Inflammatory Myositis | Annals of Internal Medicine: Clinical Cases
We describe a 21-year-old woman with bipolar disorder who started taking lamotrigine 2 months ago who presented with fever and weakness. Physical examination revealed an erythematous rash over the right thenar eminence, as well as proximal muscle weakness in bilateral upper and lower extremities. Magnetic resonance imaging of the lower extremities showed patchy bilateral enhancing myositis. Right quadriceps muscle biopsy revealed inflammatory myopathy. Subsequent bone marrow biopsy demonstrated hemophagocytic lymphohistiocytosis. The patient started a prednisone taper for suspected inflammatory myositis and achieved full remission. This is one of the first descriptions of lamotrigine inducing an autoimmune response presenting as an inflammatory myositis.
Hydroxychloroquine Cardiomyopathy—A Case Series and Review of the Literature | Annals of Internal Medicine: Clinical Cases
Cardiomyopathy is a rare but serious adverse effect of long-term hydroxychloroquine therapy, manifesting as conduction abnormalities and heart failure. Its incidence is not well established. We present the largest case series, to our knowledge, of 13 patients with endomyocardial biopsy–proven hydroxychloroquine cardiomyopathy conducted over an 8-year period at one institution. Outcomes after therapy discontinuation varied, ranging from complete resolution to progressive heart failure requiring advanced therapies, including the first reported cases of left ventricle assist device as destination therapy. Early recognition and timely drug cessation may allow for partial or full recovery of cardiac function.
Symptomatic Methemoglobinemia at Low Levels in a Patient With Obstructive Sleep Apnea | Annals of Internal Medicine: Clinical Cases
Previously reported cases of hypoxemia secondary to methemoglobinemia usually had measured methemoglobin percentages of around 20% or greater. We report an unusual case of methemoglobinemia secondary to dapsone use in a 66-year-old man with obstructive sleep apnea who presented with dyspnea and hypoxia with a methemoglobin percentage of less than 10%.
Renal Subcapsular Hematoma: A Rare Potentially Reversible Cause of Acute Graft Dysfunction With Immediate Intervention | Annals of Internal Medicine: Clinical Cases
Subcapsular hematoma of the kidney allograft is an often underrecognized but reversible cause of acute graft dysfunction, which occurs most commonly after percutaneous biopsy. We retrospectively reviewed 4 cases diagnosed with subcapsular hematoma between 2020 and 2023. All patients developed acute kidney injury, hypertension, and graft pain following kidney biopsy. Only 1 recovered fully after prompt surgical evacuation; delayed presentation and intervention in the others resulted in permanent graft loss. These findings emphasize the need for high index of suspicion in post-biopsy patients with acute graft dysfunction, as early diagnosis and timely intervention are essential for preserving graft function.
Unusual Extra-intestinal Manifestations of Crohn Disease Complicated by Incidentally Diagnosed Pancreatic Neuroendocrine Tumor | Annals of Internal Medicine: Clinical Cases
Crohn disease is associated with nonnecrotizing epithelioid granulomas, which rarely involve extra-intestinal solid organs. Management of moderate-to-severe Crohn disease, especially with extra-intestinal manifestations, relies on biologic therapies and small molecules which suppress the immune system and potentially increase cancer risk. We present the diagnosis and management of a rare case of Crohn disease with nonnecrotizing epithelioid granulomas in the sacral spine, pancreas, and peripancreatic soft tissue, complicated by an incidentally diagnosed pancreatic neuroendocrine tumor.
Insights Into a Hypercoagulable Case of Thyrocardiac Disease and Literature Overview | Annals of Internal Medicine: Clinical Cases
Hyperthyroidism is associated with a hypercoagulable state and has been described previously in case studies in the context of cerebral vein thrombosis and pulmonary emboli. In this case report, we present a middle-aged man with a rare combination of rheumatic mitral valve disease and thyroid storm complicated by enormous intracardiac thrombus burden. We aim to highlight the hypercoagulable state associated with thyrocardiac disease and to alert the physician to remain vigilant for not only this clinical entity but also for multiple disease states occurring in 1 patient.