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Displaying 391 - 400 of 7609 in ACP Online
Noteworthy Resources
Well-being Champion Training: Coaching Revisit your coaching curriculum for a refresher. This training explains coaching and the role you may decide to assume as an ACP WBC peer coach. Even if you decide not to be a peer coach, the techniques you will learn in this training will help you succeed in your role as a WBC.
In the News
Benefits of Coaching by Institute of Coaching McLean, Affiliate of Harvard Medical School Explore evidence-based coaching research and the benefits of coaching for individuals and organizations. Read Now! Effect of a Novel Online Group-Coaching Program to Reduce Burnout in Female Resident Physicians by Tyra Fainstad, MD, Adrienne Mann, MD, Krithika Suresh, PhD, et al JAMA Network
From the Trenches
Supporting a Colleague in Need by Kerri Palamara, MD, MACP Looking out for colleagues is an important role of Well-being Champions, and one that is more important than ever. A 2021 Physicians Foundation study (1) of 2500 physicians found that nearly 6 in 10 physicians reported experiencing inappropriate feelings of anger, tearfulness, or anxiety, and nearly 5 in 10 have withdrawn or isolated themselves from others. In addition, one-third of physicians reported feeling hopeless or without a purpose.
ACP Multimedia Education
Game Plan Refresh Series for Trained WBCs Marion McCrary, MD, FACP, and NC Well-being Champion (WBC), revisits strategies learned during your WBC training and new skills to grow your toolkit to support you and your colleagues. Revisit Coaching Skills of GROW and Appreciative Inquiry Watch Video
January 20, 2023
Coaching Resources for Well-being Champions
Patients Before Paperwork
Advocacy in Action Now available: ACP's 2023 end-of-year graphic demonstrating ACP's advocacy in action. View here! ACP and the AMA AMA House of Delegates Takes Action on Medicare Payment, Prior Authorization, Physician Network Inadequacies and More
Noteworthy Resources
How to Ask Coaching Questions Carol Kauffman, PhD, ABPP, PCC, founder and co-chair of the Institute of Coaching at McLean, Affiliate of Harvard Medical School, shares an overview of and foundational skills for asking coaching questions. View here!
In the News
Benefits of Coaching for Individuals and Organizations by Institute of Coaching McLean, Affiliate of Harvard Medical School Explore evidence-based coaching research and the benefits of coaching for individuals and organizations. Read Now! Research IDs Factors Linked to Internal Medicine Resident Flourishing by Elana Gotkine
From the Trenches
Supporting a Colleague in Need by Kerri Palamara, MD, MACP Republished from the January 2023 issue of I.M. Thriving
ACP Multimedia Education
Mini But Mighty Skills for Well-being: Appreciative Inquiry (15 minutes) View here!
Displaying 391 - 400 of 6848 in Annals of Internal Medicine
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Viral Load–Based Prediction of Hepatocellular Carcinoma Risk in Noncirrhotic Patients With Chronic Hepatitis B: A Multinational Study for the Development and External Validation of a New Prognostic Model: Annals of Internal Medicine: Vol 177, No 10
Background: A nonlinear association between serum hepatitis B virus (HBV) DNA levels and hepatocellular carcinoma (HCC) risk has been suggested in patients with chronic hepatitis B (CHB). Objective: To develop and externally validate a prognostic model for HCC risk in noncirrhotic adult patients with CHB and no notable alanine aminotransferase (ALT) elevation. Design: Multinational cohort study. Setting: A community-based cohort in Taiwan (REVEAL-HBV [Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer-Hepatitis B Virus]; REACH-B [Risk Estimation for HCC in CHB] model cohort) and 8 hospital-based cohorts from Korea and Hong Kong (GAG-HCC [Guide with Age, Gender, HBV DNA-HCC] and CU-HCC [Chinese University-HCC] cohorts). Participants: Model development: 6949 patients with CHB from a Korean hospital-based cohort. External validation: 7429 patients with CHB combined from the Taiwanese cohort and 7 cohorts from Korea and Hong Kong. Measurements: Incidence of HCC. Results: Over median follow-up periods of 10.0 and 12.2 years, the derivation and validation cohorts identified 435 and 467 incident HCC cases, respectively. Baseline HBV DNA level was one of the strongest predictors of HCC development, demonstrating a nonlinear parabolic association in both cohorts, with moderate viral loads (around 6 log10 IU/mL) showing the highest HCC risk. Additional predictors included in the new model (Revised REACH-B) were age, sex, platelet count, ALT levels, and positive hepatitis B e antigen result. The model exhibited satisfactory discrimination and calibration, with c-statistics of 0.844 and 0.813 in the derivation and validation cohorts with multiple imputation, respectively. The model yielded a greater positive net benefit compared with other strategies in the 0% to 18% threshold. Limitation: Validation in cohorts of other races and receiving antiviral treatment was lacking. Conclusion: Our new prognostic model, based on the nonlinear association between HBV viral loads and HCC risk, provides a valuable tool for predicting and stratifying HCC risk in noncirrhotic patients with CHB who are not currently indicated for antiviral treatment. Primary Funding Source: Korean government.
The Ethics of Cancer Screening Based on Race and Ethnicity
Racial and ethnic disparities in incidence and mortality are well documented for many types of cancer. As a result, there is understandable policy and clinical interest in race- and ethnicity-based clinical screening guidelines to address cancer health disparities. Despite the theoretical benefits, such proposals do not typically address associated ethical considerations. Using the examples of gastric cancer and esophageal adenocarcinoma, which have demonstrated disparities according to race and ethnicity, this article examines relevant ethical arguments in considering screening based on race and ethnicity. Race- and ethnicity-based clinical preventive care services have the potential to improve the balance of harms and benefits of screening. As a result, programs focused on high-risk racial or ethnic groups could offer a practical alternative to screening the general population, in which the screening yield may be too low to demonstrate sufficient effectiveness. However, designing screening according to socially based categorizations such as race or ethnicity is controversial and has the potential for intersectional stigma related to social identity or other structurally mediated environmental factors. Other ethical considerations include miscategorization, unintended negative effects on health disparities, disregard for underlying risk factors, and the psychological costs of being assigned higher risk. Given the ethical considerations, the practical application of race and ethnicity in cancer screening is most relevant in multicultural countries if and only if alternative proxies are not available. Even in those instances, policymakers and clinicians should carefully address the ethical considerations within the historical and cultural context of the intended population. Further research on alternative proxies, such as social determinants of health and culturally based characteristics, could provide more adequate factors for risk stratification.
The Annual Cost of Cancer Screening in the United States
Background: Cancer has substantial health, quality-of-life, and economic impacts. Screening may decrease cancer mortality and treatment costs, but the cost of screening in the United States is unknown. Objective: To estimate the annual cost of initial cancer screening (that is, screening without follow-up costs) in the United States in 2021. Design: Model using national health care survey and cost resources data. Setting: U.S. health care systems and institutions. Participants: People eligible for breast, cervical, colorectal, lung, and prostate cancer screening with available data. Measurements: The number of people screened and associated health care system costs by insurance status in 2021 dollars. Results: Total health care system costs for initial cancer screenings in the United States in 2021 were estimated at $43 billion. Approximately 88.3% of costs were attributable to private insurance; 8.5% to Medicare; and 3.2% to Medicaid, other government programs, and uninsured persons. Screening for colorectal cancer represented approximately 64% of the total cost; screening colonoscopy represented about 55% of the total. Facility costs (amounts paid to facilities where testing occurred) were major drivers of the total estimated costs of screening. Limitations: All data on receipt of cancer screening are based on self-report from national health care surveys. Estimates do not include costs of follow-up for positive or abnormal screening results. Variations in costs based on geography and provider or health care organization are not fully captured. Conclusion: The $43 billion estimated annual cost for initial cancer screening in the United States in 2021 is less than the reported annual cost of cancer treatment in the United States in the first 12 months after diagnosis. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities, particularly for enhancing access to recommended cancer screening services. Primary Funding Source: None.
Glucagon-Like Peptide-1 Receptor Agonists and Risk for Suicidal Ideation and Behaviors in U.S. Older Adults With Type 2 Diabetes: A Target Trial Emulation Study: Annals of Internal Medicine: Vol 177, No 8
Background: A major concern has recently emerged about a potential link between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and increased risk for suicidal ideation and behaviors based on International Classification of Diseases codes. Objective: To investigate the association between GLP-1 RAs, compared with sodium–glucose cotransporter-2 inhibitors (SGLT2is) or dipeptidyl peptidase-4 inhibitors (DPP4is), and risk for suicidal ideation and behaviors in older adults with type 2 diabetes (T2D). Design: Two target trial emulation studies comparing propensity score (PS)–matched cohorts for GLP-1 RAs versus SGLT2is and GLP-1 RAs versus DPP4is. Setting: U.S. national Medicare administrative data from January 2017 to December 2020. Patients: Older adults (≥66 years) with T2D; no record of suicidal ideation or behaviors; and a first prescription for a GLP-1 RA, SGLT2i, or DPP4i. Measurements: The primary end point was a composite of suicidal ideation and behaviors. New GLP-1 RA users were matched 1:1 on PS to new users of an SGLT2i or DPP4i in each pairwise comparison. A Cox proportional hazards regression was used to estimate the hazard ratio (HR) and 95% CIs within matched groups. Results: This study included 21 807 pairs of patients treated with a GLP-1 RA versus an SGLT2i and 21 402 pairs of patients treated with a GLP-1 RA versus a DPP4i. The HR of suicidal ideation and behaviors associated with GLP-1 RAs relative to SGLT2is was 1.07 (95% CI, 0.80 to 1.45; rate difference, 0.16 [CI, −0.53 to 0.86] per 1000 person-years); the HR relative to DPP4is was 0.94 (CI, 0.71 to 1.24; rate difference, −0.18 [CI, −0.92 to 0.57] per 1000 person-years). Limitations: Low event rate; imprecise estimates; unmeasured confounders, such as body mass index; and potential misclassification of outcomes. Conclusion: Among Medicare beneficiaries with T2D, this study found no clear increased risk for suicidal ideation and behaviors with GLP-1 RAs, although estimates were imprecise and a modest adverse risk could not be ruled out. Primary Funding Source: American Foundation for Pharmaceutical Education, Pharmaceutical Research and Manufacturers of America Foundation, National Institute on Aging, and National Institute of Diabetes and Digestive and Kidney Diseases.
Pain Reduction With Oral Methotrexate in Knee Osteoarthritis: A Randomized, Placebo-Controlled Clinical Trial: Annals of Internal Medicine: Vol 177, No 9
Background: Treatments for osteoarthritis (OA) are limited. Previous small studies suggest that the antirheumatic drug methotrexate may be a potential treatment for OA pain. Objective: To assess symptomatic benefits of methotrexate in knee OA (KOA). Design: A multicenter, randomized, double-blind, placebo-controlled trial done between 13 June 2014 and 13 October 2017. (ISRCTN77854383; EudraCT: 2013-001689-41) Setting: 15 secondary care musculoskeletal clinics in the United Kingdom. Participants: A total of 207 participants with symptomatic, radiographic KOA and knee pain (severity ≥4 out of 10) on most days in the past 3 months with inadequate response to current medication were approached for inclusion. Intervention: Participants were randomly assigned 1:1 to oral methotrexate once weekly (6-week escalation 10 to 25 mg) or matched placebo over 12 months and continued usual analgesia. Measurements: The primary end point was average knee pain (numerical rating scale [NRS] 0 to 10) at 6 months, with 12-month follow-up to assess longer-term response. Secondary end points included knee stiffness and function outcomes and adverse events (AEs). Results: A total of 155 participants (64% women; mean age, 60.9 years; 50% Kellgren–Lawrence grade 3 to 4) were randomly assigned to methotrexate (n = 77) or placebo (n = 78). Follow-up was 86% (n = 134; methotrexate: 66, placebo: 68) at 6 months. Mean knee pain decreased from 6.4 (SD, 1.80) at baseline to 5.1 (SD, 2.32) at 6 months in the methotrexate group and from 6.8 (SD, 1.62) to 6.2 (SD, 2.30) in the placebo group. The primary intention-to-treat analysis showed a statistically significant pain reduction of 0.79 NRS points in favor of methotrexate (95% CI, 0.08 to 1.51; P = 0.030). There were also statistically significant treatment group differences in favor of methotrexate at 6 months for Western Ontario and McMaster Universities Osteoarthritis Index stiffness (0.60 points [CI, 0.01 to 1.18]; P = 0.045) and function (5.01 points [CI, 1.29 to 8.74]; P = 0.008). Treatment adherence analysis supported a dose-response effect. Four unrelated serious AEs were reported (methotrexate: 2, placebo: 2). Limitation: Not permitting oral methotrexate to be changed to subcutaneous delivery for intolerance. Conclusion: Oral methotrexate added to usual medications demonstrated statistically significant reduction in KOA pain, stiffness, and function at 6 months. Primary Funding Source: Versus Arthritis.
Displaying 391 - 400 of 3144 in IM Matters
Displaying 391 - 400 of 2393 in ACP Hospitalist
Displaying 391 - 400 of 500 in Annals of Internal Medicine: Clinical Cases
Atypical Hemolytic Uremic Syndrome Precipitated by Recurrent Pancreatitis | Annals of Internal Medicine: Clinical Cases
Atypical hemolytic uremic syndrome presents with negative direct antiglobulin test microangiopathic hemolytic anemia, acute kidney injury, and thrombocytopenia in the absence of diarrhea. Atypical hemolytic uremic syndrome may be triggered by drugs, infections, systemic lupus erythematosus, or, rarely, pancreatitis. Furthermore, recurrent hemolytic uremic syndrome should raise suspicion for complement-mediated atypical hemolytic uremic syndrome treated with eculizumab, an anti-C5 monoclonal antibody. Here, we report a case of complement-mediated atypical hemolytic uremic syndrome likely precipitated by recurrent alcohol-induced pancreatitis.
An Incidental Finding of Spontaneous Hepatic Artery Thrombosis in a Healthy Patient | Annals of Internal Medicine: Clinical Cases
Hepatic artery thrombosis (HAT) outside the setting of liver transplantation is exceedingly rare. Few cases of HAT leading to hepatic infarction have been reported, and management strategies have varied from symptom control to anticoagulation and antiplatelet therapy. Cases of spontaneous HAT without hepatic dysfunction, however, have not been previously reported. We report the case of an incidentally found spontaneous HAT without signs of hepatic dysfunction or injury in an otherwise healthy 45-year-old woman. Treatment consisted of therapeutic anticoagulation and antiplatelet therapy. Resolution of the HAT was confirmed by follow-up ultrasound imaging, and the patient remained free of HAT at 12-month follow-up magnetic resonance imaging.
Pulmonary Mucormycosis With Dissemination: A Case of Unrelenting Fever and Chest Pain | Annals of Internal Medicine: Clinical Cases
Pulmonary mucormycosis is a rare entity that requires a high index of clinical suspicion for diagnosis. Untreated mucormycosis results in dissemination with exceedingly high mortality rates. Here, we present the patient case of a previously healthy 21-year-old man who presented with fever, dyspnea, chest pain, and progressive pulmonary consolidation. This patient case highlights the expanded differential diagnosis of presumed bacterial pneumonia that fails to respond to initial management and details the clinical, radiographic, and pathologic findings consistent with diagnosing pulmonary mucormycosis.
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.
Diffuse Necrosis: A Rare Case of Idiopathic Black Esophagus, Duodenum, and Jejunum | Annals of Internal Medicine: Clinical Cases
Black esophagus, or acute esophageal necrosis (AEN), is a rare, life-threatening disorder that typically presents in patients who have multiple comorbid conditions and is essential to diagnose as soon as possible. Although AEN is commonly seen in patients who are critically ill, it is unusual for patients to have mild subjective symptoms and otherwise remain clinically stable. We present a peculiar case of a patient who had endoscopic findings showing extensive necrosis of his esophagus, duodenum, and jejunum with sparing of the stomach and only mild symptomatology.
A Tale of Two Hematological Malignancies: CML Followed by CLL in the Same Patient | Annals of Internal Medicine: Clinical Cases
Studies have reported second malignancies occurring in patients with chronic myeloid leukemia (CML) or chronic lymphoid leukemia (CLL). We discuss the case of a 77-year-old man diagnosed with CLL who later developed CML. The CLL was managed with surveillance after diagnosis for 3 years and later treated with ibrutinib and venetoclax. While on treatment with venetoclax for 4 months, the patient had worsening leukocytosis shown via peripheral flow cytometry and fluorescence in situ hybridization, with the presence of myeloid lineage cells positive for BCR-ABL and complete disappearance of lymphoid cells. This case report highlights the importance of considering a second malignancy in hematologic malignancies with variable disease prognosis.
Levetiracetam-Induced Pancytopenia in an HIV Seropositive Patient With SARS-CoV-2 | Annals of Internal Medicine: Clinical Cases
Levetiracetam is a widely used and safe antiepileptic drug, and levetiracetam-induced pancytopenia is an uncommon adverse effect. We present a patient case of a middle-aged man with seizures who developed profound pancytopenia within 4 days of starting levetiracetam. We suspected levetiracetam-induced pancytopenia, withdrew the levetiracetam, and started our patient on an alternative medication, which improved his blood count within 24 hours. This is the first patient case demonstrating levetiracetam-induced pancytopenia in an adult with coexisting HIV and SARS-CoV-2 infections, which did not contribute to his pancytopenia. Physicians should be cognizant of this adverse effect when prescribing levetiracetam to treat seizures.
A Case of Maple Syrup Urine Disease Diagnosed in Adulthood | Annals of Internal Medicine: Clinical Cases
Classic maple syrup urine disease (MSUD) is typically diagnosed in newborns, whereas nonclassic forms may manifest at any age. We describe a 58-year-old man presenting with recurrent encephalopathy, found with a nonclassic form of MSUD. This patient case highlights the importance of considering inborn errors of metabolism in the differential diagnosis of adult patients presenting with neurologic symptoms of unclear cause.
Pleural and Pericardial Plaques in Asbestos Exposure | Annals of Internal Medicine: Clinical Cases
Asbestos is a generic term for a group of naturally occurring fibers composed of hydrated magnesium silicate minerals. Transported worldwide to shipyards and factories, it is a material that was widely used in construction, mining, and manufacturing. Exposure to asbestos can cause significant benign and malignant lung, pleural, and pericardial disease. Usually asymptomatic, pleural plaques are the most common radiologic manifestation of asbestos exposure. We report a case of a man who presented with heart failure exacerbation and was incidentally found to have pleural and pericardial plaques from asbestos exposure.