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Search Results for "american academy"
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Displaying 11 - 20 of 1179 in Policy Library
Displaying 11 - 20 of 28 in Performance Measures
Quality of Life Assessment for Patients with Primary Headache Disorders
Percentage of patients with a diagnosis of primary headache disorder whose health related quality of life (HRQoL) was assessed with a tool(s) during at least two visits during the 12 month measurement period AND whose health related quality of life score stayed the same or improved.
Pharmacologic Therapy for Persistent Asthma
INACTIVE REVIEW: This measure review is older than five years. Percentage of patient aged 5 through 64 years with a diagnosis of persistent asthma who were prescribed long-term control medication Three rates are reported for this measure: Patients prescribed inhaled corticosteroids (ICS) as their long term control medication Patients prescribed other alternative long term control medications (non-ICS) Total patients prescribed long-term control medication
Overuse of Neuroimaging for patients with Primary Headache and a Normal Neurological Evaluation
Percentage of patients with a diagnosis of primary headache disorder whom advanced brain imaging was not ordered.
Osteoarthritis: Function and Pain Assessment
Percentage of patient visits for patients aged 21 years and older with a diagnosis of osteoarthritis (OA) with assessment for function and pain.
Opioid Therapy: Follow-up Evaluation
All patients 18 and older prescribed opiates for longer than six weeks duration who had a follow-up evaluation conducted at least every three months during Opioid Therapy documented in the medical record.
More Than One CT Scan Within 90 Days for Chronic Sinusitis
Percentage of patients aged 18 years and older with a diagnosis of chronic sinusitis who had more than one CT scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis.
Management of Neuropsychiatric Symptoms
Percentage of patients, regardless of age, with a diagnosis of dementia who have one or more neuropsychiatric symptoms who received or were recommended to receive an intervention for neuropsychiatric symptoms within a 12 month period
Evaluation or Interview for Risk of Opioid Misuse
All patients 18 and older prescribed opiates for longer than six weeks duration evaluated for risk of opioid misuse using a brief validated instrument (e.g. Opioid Risk Tool, SOAPP-R) or patient interview documented at least once during Opioid Therapy in the medical record.
Epilepsy: Counseling for Women of Childbearing Potential with Epilepsy
All female patients of childbearing potential (12 - 44 years old) diagnosed with epilepsy who were counseled or referred for counseling for how epilepsy and its treatment may affect contraception OR pregnancy at least once a year.
Documentation of Signed Opioid Treatment Agreement
All patients 18 and older prescribed opiates for longer than six weeks duration who signed an opioid treatment agreement at least once during Opioid Therapy documented in the medical record.
Displaying 11 - 20 of 1285 in Annals of Internal Medicine
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Brief Cognitive Tests for Distinguishing Clinical Alzheimer-Type Dementia From Mild Cognitive Impairment or Normal Cognition in Older Adults With Suspected Cognitive Impairment: A Systematic Review: Annals of Internal Medicine: Vol 172, No 10
Background: The accuracy and harms of brief cognitive tests for identifying clinical Alzheimer-type dementia (CATD) are uncertain. Purpose: To summarize evidence on accuracy and harms of brief cognitive tests for CATD in older adults with suspected cognitive impairment. Data Sources: Electronic bibliographic databases (from inception to November 2019) and systematic review bibliographies. Study Selection: English-language, controlled observational studies in older adults that evaluated the accuracy of brief cognitive tests (standalone tests; memory, executive function, and language tests; and brief multidomain batteries) for distinguishing CATD from mild cognitive impairment (MCI) or normal cognition as defined by established diagnostic criteria. Studies with low or medium risk of bias (ROB) were analyzed. Data Extraction: Two reviewers rated ROB. One reviewer extracted data; the other verified extraction accuracy. Data Synthesis: Fifty-seven studies met analysis criteria. Many brief, single cognitive tests were highly sensitive and specific for distinguishing CATD from normal cognition. These included standalone tests (clock-drawing test, median sensitivity 0.79 and specificity 0.88 [8 studies]; Mini-Mental State Examination, 0.88 and 0.94 [7 studies]; Montreal Cognitive Assessment, 0.94 and 0.94 [2 studies]; and Brief Alzheimer Screen, 0.92 and 0.97 [1 study]), memory tests (list delayed recall, 0.89 and 0.94 [5 studies]), and language tests (category fluency, 0.92 and 0.89 [9 studies]). Accuracy was lower in distinguishing mild CATD from normal cognition and distinguishing CATD from MCI. No studies reported on testing harms. Limitations: Studies were small. Few test metrics were evaluated by multiple studies. Few studies directly compared different tests, scores, cut points, or test combinations. Conclusion: Many brief, single cognitive tests accurately distinguish CATD from normal cognition in older adults but are less accurate in distinguishing mild CATD from normal cognition or CATD from MCI. No studies reported on testing harms. Primary Funding Source: Agency for Healthcare Research and Quality. (PROSPERO: CRD42018117897)
Accuracy of Biomarker Testing for Neuropathologically Defined Alzheimer Disease in Older Adults With Dementia: A Systematic Review: Annals of Internal Medicine: Vol 172, No 10
Background: Biomarker accuracy for Alzheimer disease (AD) is uncertain. Purpose: To summarize evidence on biomarker accuracy for classifying AD in older adults with dementia. Data Sources: Electronic bibliographic databases (searched from January 2012 to November 2019 for brain imaging and cerebrospinal fluid [CSF] tests and from inception to November 2019 for blood tests), ClinicalTrials.gov (to November 2019), and systematic review bibliographies. Study Selection: English-language studies evaluating the accuracy of brain imaging, CSF testing, or blood tests for distinguishing neuropathologically defined AD from non-AD among older adults with dementia. Studies with low or medium risk of bias were analyzed. Data Extraction: Two reviewers rated risk of bias. One extracted data; the other verified accuracy. Data Synthesis: Fifteen brain imaging studies and 9 CSF studies met analysis criteria. Median sensitivity and specificity, respectively, were 0.91 and 0.92 for amyloid positron emission tomography (PET), 0.89 and 0.74 for 18F-labeled fluorodeoxyglucose (18F-FDG) PET, 0.64 and 0.83 for single-photon emission computed tomography, and 0.91 and 0.89 for medial temporal lobe atrophy on magnetic resonance imaging (MRI). Individual CSF biomarkers and ratios had moderate sensitivity (range, 0.62 to 0.83) and specificity (range, 0.53 to 0.69); in the few direct comparisons, β-amyloid 42 (Aβ42)/phosphorylated tau (p-tau) ratio, total tau (t-tau)/Aβ42 ratio, and p-tau appeared more accurate than Aβ42 and t-tau alone. Single studies suggested that amyloid PET, 18F-FDG PET, and CSF test combinations may add accuracy to clinical evaluation. Limitations: Studies were small, biomarker cut points and neuropathologic AD were inconsistently defined, and methods with uncertain applicability to typical clinical settings were used. Few studies directly compared biomarkers, assessed test combinations, evaluated whether biomarkers improved classification accuracy when added to clinical evaluation, or reported harms. Conclusion: In methodologically heterogeneous studies of uncertain applicability to typical clinical settings, amyloid PET, 18F-FDG PET, and MRI were highly sensitive for neuropathologic AD. Amyloid PET, 18F-FDG PET, and CSF test combinations may add accuracy to clinical evaluation. Primary Funding Source: Agency for Healthcare Research and Quality. (PROSPERO: CRD42018117897)
Benefits and Harms of Prescription Drugs and Supplements for Treatment of Clinical Alzheimer-Type Dementia: A Systematic Review and Meta-analysis: Annals of Internal Medicine: Vol 172, No 10
Background: Effects of drug treatment of clinical Alzheimer-type dementia (CATD) are uncertain. Purpose: To summarize evidence on the effects of prescription drugs and supplements for CATD treatment. Data Sources: Electronic bibliographic databases (inception to November 2019), ClinicalTrials.gov (to November 2019), and systematic review bibliographies. Study Selection: English-language trials of prescription drug and supplement treatment in older adults with CATD that report cognition, function, global measures, behavioral and psychological symptoms of dementia (BPSD), or harms. Minimum treatment was 24 weeks (≥2 weeks for selected BPSD). Data Extraction: Studies with low or medium risk of bias (ROB) were analyzed. Two reviewers rated ROB. One reviewer extracted data; another verified extraction accuracy. Data Synthesis: Fifty-five studies reporting non-BPSD outcomes (most ≤26 weeks) and 12 reporting BPSD (most ≤12 weeks) were analyzed. Across CATD severity, mostly low-strength evidence suggested that, compared with placebo, cholinesterase inhibitors produced small average improvements in cognition (median standardized mean difference [SMD], 0.30 [range, 0.24 to 0.52]), no difference to small improvement in function (median SMD, 0.19 [range, −0.10 to 0.22]), no difference in the likelihood of at least moderate improvement in global clinical impression (median absolute risk difference, 4% [range, 2% to 4%]), and increased withdrawals due to adverse events. In adults with moderate to severe CATD receiving cholinesterase inhibitors, low- to insufficient-strength evidence suggested that, compared with placebo, add-on memantine inconsistently improved cognition and improved global clinical impression but not function. Evidence was mostly insufficient about prescription drugs for BPSD and about supplements for all outcomes. Limitation: Most drugs had few trials without high ROB, especially for supplements, active drug comparisons, BPSD, and longer trials. Conclusion: Cholinesterase inhibitors and memantine slightly reduced short-term cognitive decline, and cholinesterase inhibitors slightly reduced reported functional decline, but differences versus placebo were of uncertain clinical importance. Evidence was mostly insufficient on drug treatment of BPSD and on supplements for all outcomes. Primary Funding Source: Agency for Healthcare Research and Quality. (PROSPERO: CRD42018117897)
Management of Acute Pain From Non–Low Back, Musculoskeletal Injuries: A Systematic Review and Network Meta-analysis of Randomized Trials: Annals of Internal Medicine: Vol 173, No 9
Background: Patients and clinicians can choose from several treatment options to address acute pain from non–low back, musculoskeletal injuries. Purpose: To assess the comparative effectiveness of outpatient treatments for acute pain from non–low back, musculoskeletal injuries by performing a network meta-analysis of randomized clinical trials (RCTs). Data Sources: MEDLINE, EMBASE, CINAHL, PEDro (Physiotherapy Evidence Database), and Cochrane Central Register of Controlled Trials to 2 January 2020. Study Selection: Pairs of reviewers independently identified interventional RCTs that enrolled patients presenting with pain of up to 4 weeks' duration from non–low back, musculoskeletal injuries. Data Extraction: Pairs of reviewers independently extracted data. Certainty of evidence was evaluated by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Data Synthesis: The 207 eligible studies included 32 959 participants and evaluated 45 therapies. Ninety-nine trials (48%) enrolled populations with diverse musculoskeletal injuries, 59 (29%) included patients with sprains, 13 (6%) with whiplash, and 11 (5%) with muscle strains; the remaining trials included various injuries ranging from nonsurgical fractures to contusions. Topical nonsteroidal anti-inflammatory agents (NSAIDs) proved to have the greatest net benefit, followed by oral NSAIDs and acetaminophen with or without diclofenac. Effects of these agents on pain were modest (around 1 cm on a 10-cm visual analogue scale, approximating the minimal important difference). Regarding opioids, compared with placebo, acetaminophen plus an opioid improved intermediate pain (1 to 7 days) but not immediate pain (≤2 hours), tramadol was ineffective, and opioids increased the risk for gastrointestinal and neurologic harms (all moderate-certainty evidence). Limitations: Only English-language studies were included. The number of head-to-head comparisons was limited. Conclusion: Topical NSAIDs, followed by oral NSAIDs and acetaminophen with or without diclofenac, showed the most convincing and attractive benefit–harm ratio for patients with acute pain from non–low back, musculoskeletal injuries. No opioid achieved benefit greater than that of NSAIDs, and opioids caused the most harms. Primary Funding Source: National Safety Council. (PROSPERO: CRD42018094412)
Predictors of Prolonged Opioid Use After Initial Prescription for Acute Musculoskeletal Injuries in Adults: A Systematic Review and Meta-analysis of Observational Studies: Annals of Internal Medicine: Vol 173, No 9
Background: Opioids are frequently prescribed for acute musculoskeletal injuries and may result in long-term use and consequent harms. Purpose: To explore factors associated with persistent opioid use after its prescription for acute musculoskeletal injury. Data Sources: Searches of multiple electronic databases, without language restrictions, from inception to 6 January 2020, and reference lists of selected articles. Study Selection: Observational studies of adults with opioid prescriptions for outpatient acute musculoskeletal injuries, in an adjusted model, that explored risk factors for prolonged use. Data Extraction: 6 reviewers, working in pairs, independently extracted data, rated the quality of studies, and evaluated the certainty of evidence. Data Synthesis: 14 cohorts with 13 263 393 participants were included. The overall prevalence of prolonged opioid use after musculoskeletal injury for high-risk populations (that is, patients receiving workers' compensation benefits, Veterans Affairs claimants, or patients with high rates of concurrent substance use disorder) was 27% (95% CI, 18% to 37%). The prevalence among low-risk populations was 6% (CI, 4% to 8%; P for interaction < 0.001). Moderate-certainty evidence showed increased odds of persistent opioid use with older age (absolute risk increase [ARI] for every 10-year increase, 1.1% [CI, 0.7% to 1.5%]) and physical comorbidity (ARI, 0.9% [CI, 0.1% to 1.7%]). Low-certainty evidence suggested increased risk for persistent opioid use with past or current substance use disorder (ARI, 10.5% [CI, 4.2% to 19.8%]), prescriptions lasting more than 7 days (median ARI, 4.5%), and higher morphine milligram equivalents per day. Limitation: Sparse, heterogeneous data with suboptimal adjustment for potential confounders. Conclusion: Avoiding prescribing opioids for acute musculoskeletal injuries to patients with past or current substance use disorder, and restricting duration to 7 days or less and using lower doses when they are prescribed, are potentially important targets to reduce rates of persistent opioid use. Primary Funding Source: National Safety Council. (PROSPERO: CRD42018104968)
Displaying 11 - 15 of 15 in Annals of Internal Medicine: Clinical Cases
Lactobacillus Endocarditis With Mixed Glomerulonephritis: A Case Report | Annals of Internal Medicine: Clinical Cases
We present a case of Lactobacillus prosthetic valve endocarditis with associated antineutrophil cytoplasmic antibody glomerulonephritis. A 41-year-old man presented with recurrent dark brown urine, lower-extremity rash, and acute kidney injury. Kidney biopsy confirmed the diagnosis of glomerulonephritis, with pathologic findings concerning for an infectious cause. Blood cultures returned positive for Lactobacillus species, and transesophageal echocardiogram findings were positive for prosthetic valve vegetation. Antimicrobial and low-dose steroid therapy were initiated to treat the endocarditis with confidence that resolution of his glomerulonephritis also would occur.
Refractory Iron Deficiency Anemia Secondary to Angiodysplasia-Related Gastrointestinal Bleeding Successfully Treated With Bevacizumab | Annals of Internal Medicine: Clinical Cases
Rapidly recurrent iron deficiency anemia secondary to angiodysplasia-related gastrointestinal hemorrhage is usually difficult to treat. Management is limited to endoscopic techniques such as argon plasma coagulation, blood product transfusion, parenteral iron replacement, and elimination of drugs that predispose to bleeding. We describe 2 patients with gastrointestinal angiodysplasia and rapidly recurrent iron deficiency anemia secondary to chronic gastrointestinal bleeding who continued to be symptomatic despite multiple pharmacologic and supportive interventions. They both experienced a dramatic, rapid, and sustained response to bevacizumab. Clear guidelines on the use of bevacizumab in this setting are lacking.
A Rare Case of Kleine–Levin Syndrome Following COVID-19 | Annals of Internal Medicine: Clinical Cases
A wide variety of neuropsychiatric manifestations have been reported with COVID-19. We present a case of a 45-year-old man who developed significant hypersomnia and hypersexual thoughts following COVID-19 illness. Further evaluation did not reveal any other infection, structural brain disease, or stroke, leading us to consider Kleine–Levin syndrome as a diagnosis of exclusion. However, a confirmed diagnosis of this syndrome cannot be made on initial presentation, and its formal diagnosis requires recurrence of symptoms. Although relapses of this syndrome are known to be triggered by viral illnesses, no primary occurrences have been reported with COVID-19 to date.
First Manifestation of Adult-Onset Still Disease After COVID-19 Vaccination: Two Cases | Annals of Internal Medicine: Clinical Cases
Adult Still disease (ASD) is a rare autoinflammatory condition of unknown cause. Viral or bacterial infections can trigger the onset of ASD. We describe the clinical features, treatment, and follow-up of 2 patients with new-onset ASD following COVID-19 vector vaccination. Our cases emphasize the importance of early diagnosis and lend weight to an association between COVID-19 vector vaccination and new-onset ASD.
Acute Severe Hyperlipidemia Leading to a Diagnosis of Pancreatic Cancer in an Elderly Woman | Annals of Internal Medicine: Clinical Cases
There are multiple secondary causes of hyperlipidemia, including obstructive cholestasis. We present a patient case of a 72-year-old woman with controlled hyperlipidemia presenting for a routine primary care visit. Laboratory results showed marked hyperlipidemia. Subsequent evaluation revealed biliary obstruction resulting from pancreatic adenocarcinoma.