Search Results for "american academy"
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- Performance Measures (28)
- Annals of Internal Medicine (1282)
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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 1173 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 1282 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 10 in Annals of Internal Medicine: Clinical Cases
Evaluation of the Role of Endomyocardial Biopsy in Rare Myocardial Disorders: Six Case Reports and Narratives | Annals of Internal Medicine: Clinical Cases
This study conducts an observational analysis of 6 cases of rare myocardial diseases, aiming to clarify the diagnostic value and clinical utility of endomyocardial biopsy (EMB) in the 2007 American Heart Association, American College of Cardiology, and European Society of Cardiology guidelines and the 2020 Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America, and Japanese Heart Failure Society guidelines. Our findings indicated that certain forms of myocarditis may present with arrhythmias and other clinical scenarios, potentially leading to a lower recommendation grade in the 2007 guidelines. To enhance the yield of EMB, electroanatomical mapping systems can be used in some diseases. Endomyocardial biopsy serves as a valuable diagnostic tool in acute-onset unexplained cardiomyopathy and suspected infiltrative diseases. The complications of EMB must be taken seriously.
Ocrelizumab-Related Organizing Pneumonia: A Rare Pulmonary Complication in Multiple Sclerosis | Annals of Internal Medicine: Clinical Cases
We report a case of organizing pneumonia induced by ocrelizumab in a 65-year-old man with multiple sclerosis. The patient presented with persistent fever and progressive respiratory symptoms despite broad-spectrum antibiotic treatment. Chest imaging revealed diffuse ground-glass opacities, and a transbronchial biopsy confirmed organizing pneumonia. Corticosteroid therapy led to marked clinical improvement, and ocrelizumab was discontinued. This case highlights the importance of recognizing drug-induced organizing pneumonia in patients receiving immunomodulatory therapy, particularly when standard antibiotic treatments fail. Early identification and corticosteroid intervention are critical to avoid further complications.
Abdominal Radicular Pain From Neuroborreliosis: A Case of Bannwarth Syndrome in the Midwestern United States | Annals of Internal Medicine: Clinical Cases
A man in his mid-50s from Illinois presented with a circular rash without central clearing on his thigh. Two weeks later, he developed radicular lower abdominal and back pain. While initial imaging of the abdomen and lumbar spine was unrevealing, a physical examination later uncovered the subtle finding of dermatomal hypoesthesia. After a positive 2-tier test for Lyme disease, a diagnosis of Bannwarth syndrome was confirmed by cerebrospinal fluid, revealing lymphocytic pleocytosis and an elevated Lyme antibody index. Despite its historical association with the European Borrelia species, in the United States, Bannwarth syndrome should be considered in patients with radicular pain.
Aortic Thrombus in Severe Disseminated Lyme Disease | Annals of Internal Medicine: Clinical Cases
Lyme carditis with atrioventricular dissociation is a rare yet well-recognized complication of disseminated Lyme disease. Other cardiac and noncardiovascular conditions have been reported with disseminated Lyme disease. We present a case of severe disseminated Lyme carditis with an acute arterial thrombus, in the absence of an alternative or more common cause, which required urgent surgical intervention. To our knowledge, arterial thrombus is a previously unreported complication of disseminated Lyme carditis.
Navigating Complexity: Spontaneous Psoas Hematoma in MASLD Cirrhosis and Anticoagulation Therapy | Annals of Internal Medicine: Clinical Cases
Spontaneous psoas hematoma is a rare but highly fatal complication of alcohol-associated cirrhosis. Most cases in the literature involve alcohol-related cirrhosis, particularly in Asian populations. We present a case of a 76-year-old White man with cirrhosis due to metabolic dysfunction-associated steatotic liver disease who developed a spontaneous psoas hematoma while on anticoagulation therapy for an extensive deep venous thrombus. Despite blood products and octreotide, his condition deteriorated. After timely discussions about goals of care, treatment shifted to focus on comfort. This case highlights the challenging balance between hypercoagulability and bleeding risk in cirrhosis and illustrates a rare complication.
Post-Impella Sneeze Leading to Stroke and Emergent Cardiac Surgery | Annals of Internal Medicine: Clinical Cases
We present a rare case of stroke occurring after left ventricular support device removal. A 53-year-old man presented with left arm and left leg weakness that began after sneezing. He had been discharged 5 months previously after an Impella-supported coronary artery bypass graft. Computed tomography angiography scan of the chest showed a clot attached to the Impella graft from his previous surgery. Magnetic resonance imaging scan of the brain revealed multiple embolic infarcts. The graft and clots were removed successfully, and the patient's symptoms improved. This is the first reported case, to our knowledge, of stroke occurring months after Impella removal.
Capnocytophagia Meningitis Secondary to Dog Bite to the Face | Annals of Internal Medicine: Clinical Cases
Capnocytophagia canimorsus is known to cause cellulitis, septicemia, endocarditis, and meningitis, most commonly in an immunocompromised host following an animal bite injury. Here, we describe an unusual case of Capnocytophagia meningitis in an immunocompetent host without classic risk factors. The severity of presentation was believed to be related to the high-risk location of the dog bite near the danger triangle of the face.
Clinical Presentation and Diagnostic Work-up of Epiploic Appendagitis | Annals of Internal Medicine: Clinical Cases
Epiploic appendagitis is a rare condition caused by inflammation and necrosis of the epiploic appendages, which are small fat-filled structures around the colon that cushion it and help immune response. Although it is an exceedingly uncommon and underdiagnosed cause of acute abdominal pain, it mimics more serious intra-abdominal pathology that requires a thorough work-up. This case highlights the clinical presentation, work-up, and nonoperative management of a previously healthy 41-year-old man who presented with acute right lower-quadrant pain. Because of the challenges in identifying this condition and the limited research available, the goal of this report is to highlight a unique presentation of this disease.
Intravascular Large B-Cell Lymphoma: A Case of Negative Biopsies and Hemophagocytic Lymphohistiocytosis | Annals of Internal Medicine: Clinical Cases
Intravascular large B-cell lymphoma (IVLBCL) is a rare lymphoma characterized by highly variable symptoms and intravascular spread. The disease is subclassified into 3 variants according to symptomatology and epidemiology. Diagnosis is often challenging, requiring a high index of suspicion in conjunction with targeted biopsies. We present a case of a White patient with the hemophagocytic “Asian” variant of IVLBCL. Repeated biopsies and reevaluation of pathology were required to make the diagnosis. Our case identifies strategies to augment the diagnostic yield when traditional workup is negative. It also calls into question the characterization of disease variants by geography.
Infection or Malignancy? A Novel Co-Diagnosis in a Patient After Hematopoietic Stem Cell Transplant | Annals of Internal Medicine: Clinical Cases
Patients undergoing hematopoietic stem cell transplant are susceptible to various opportunistic infections after transplantation, including reactivation of latent infections. We report a patient with acute neurologic worsening after allogeneic hematopoietic stem cell transplant complicated by chronic graft-versus-host disease who was concurrently diagnosed with cerebral toxoplasmosis and post-transplant lymphoproliferative disorder with central nervous system involvement, the first such reported co-diagnosis to our knowledge. Management of these patients can be challenging due to the continued need for immunosuppression to control graft-versus-host disease. Due to the high mortality associated with either condition, this co-diagnosis ultimately proved fatal in our patient.