Search Results for: "american academy"

Source Citation Gragnano F, Mehran R, Branca M; Single Versus Dual Antiplatelet Therapy (Sidney-2) Collaboration. P2Y12 inhibitor monotherapy or dual antiplatelet therapy after complex percutaneous coronary interventions. J Am Coll Cardiol. 2023;81:537-552. 36754514

In IgA nephropathy, oral methylprednisolone reduced adverse kidney outcomes but increased adverse events

Source Citation Lv J, Wong MG, Hladunewich MA, et al. Effect of oral methylprednisolone on decline in kidney function or kidney failure in patients with IgA nephropathy: the TESTING randomized clinical trial. JAMA. 2022;327:1888-98. 35579642

Annals Graphic Medicine - An Apple a Day

Revitalizing Primary Care Internal Medicine: Addressing the Hidden Curriculum

The Sieve of Asclepius: A History of Navigating the Medical Literature, From Index to Algorithm

For centuries, physicians have lamented the proliferating medical literature. This article traces the evolving strategies by which physicians have attempted to render this literature navigable for the purposes of research, teaching, and patient care. Beginning with John Shaw Billings’ foundational indexing work at the Library of the Surgeon General’s Office, the article examines successive (and overlapping) search regimes—including personal curation practices, abstract journals, pharmaceutical industry information services, citation indexing, and computerized retrieval systems—analyzing how each embedded value judgments about what counted as important or useful medical knowledge. Even as systems of search have evolved over time in conjunction with new technologic capabilities, business models, and search-related behavioral patterns, they have also grappled with enduring tensions between selectivity and comprehensiveness, between commercialism and scientific merit, and among the very boundaries of the conditions to be categorized and navigated. This history underscores how systems of search are not external maps of the knowledge ecosystem but are constitutive of it, influencing everything from journal rankings to research priorities to clinical practice. As literature search becomes integrated with artificial intelligence capabilities, a historical perspective helps physicians appreciate how such technologies condition what they know.

Atopic Dermatitis

Atopic dermatitis affects approximately 10% of the U.S. population and is more common in children than adults. Up to 99% of physician visits for atopic dermatitis are in primary care. Most cases can be managed successfully with topical treatments, including moisturizers and prescription anti-inflammatory treatments, such as corticosteroids, calcineurin inhibitors, phosphodiesterase-4 inhibitors, Janus kinase (JAK) inhibitors, and aryl hydrocarbon receptor agonists. For more refractory or severe atopic dermatitis, ultraviolet phototherapy and systemic treatments, usually prescribed by specialists, can be used. Systemic treatments include older off-label immunomodulators, such as methotrexate. Since 2017, multiple on-label injectable biologics and oral JAK inhibitors have been approved.

Proximal Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea in the OSPREY Study: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 0, No 0

Background: Hypoglossal nerve stimulation (HGNS) is used to treat obstructive sleep apnea (OSA); however, evidence is limited for patients who cannot tolerate positive airway pressure therapy. Proximal HGNS (pHGNS) provides multicontact stimulation of proximal nerve portions, with easier electrode implantation than distal nerve stimulation. Objective: To evaluate the efficacy and safety of pHGNS in patients with moderate-to-severe OSA. Design: 7-month randomized controlled trial followed by a 6-month open-label extension. (ClinicalTrials.gov: NCT04950894) Setting: 23 U.S. health centers. Patients: Adults aged 22 years or older with moderate-to-severe OSA. Intervention: All patients underwent implantation with pHGNS at baseline and were randomly assigned in a 2:1 ratio to treatment or control. Therapy began at month 1 (treatment) or month 7 (control). Measurements: Assessments included the proportion of patients achieving greater than 50% improvement from baseline in the apnea–hypopnea index (AHI) and AHI below 20 events/h at month 7 (primary end point), improvements in oxygen desaturation index (ODI) and patient-reported outcomes (for example, Epworth Sleepiness Scale [ESS]), and safety. Results: The 104 randomly assigned patients had a mean age of 55.6 years (SD, 9.0), body mass index of 30.6 kg/m2 (SD, 3.0), a preimplantation AHI of 35.7 events/h (SD, 12.8), and a preimplantation ODI of 36.7 events/h (SD, 13.4). At month 7, 58.2% (95% CI, 45.5% to 70.2%) of patients assigned to treatment (n = 67) versus 13.5% (CI, 4.5% to 28.8%) assigned to control (n = 37) achieved the primary end point, and ODI was reduced by at least 25% in 68.7% (CI, 56.2% to 79.4%) versus 37.8% (CI, 22.5% to 55.2%) of patients, respectively. Median ESS score improved from baseline to month 7 in the treatment group (10.0 [IQR, 7.0 to 14.0] to 6.0 [IQR, 5.0 to 9.0]) but not in the control group (9.0 [IQR, 7.0 to 11.0] to 9.0 [IQR, 6.0 to 11.0]). No serious procedure-related adverse events were reported. Limitations: Lack of blinding, small sample size, and short follow-up. Conclusion: pHGNS for OSA yielded clinically significant responses versus control at month 7, supporting pHGNS as a therapeutic option for OSA. Primary Funding Source: LivaNova PLC.

Frailty

Frailty is a syndrome of decreased reserve across multiple physiologic systems that is associated with greater risk for hospitalizations, disability, institutionalization, and other adverse outcomes, including mortality. Patients with frailty, most of whom are older adults, may be more likely to experience adverse outcomes due to iatrogenic causes, such as higher-risk medications or procedures. Guidelines recommend frailty screening for both chronic disease management and in-hospital care, as identification of frailty allows for risk mitigation and alignment of care with patients’ goals. In addition, some interventions may delay or reverse frailty, thus increasing physiologic reserve and improving day-to-day function. This article reviews frailty definitions, approaches to assessment in different care settings, and management.

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