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Displaying 441 - 450 of 7609 in ACP Online
Leveraging Telehealth for Chronic Disease Management in Ambulatory Care
Practicing internists share their experiences using video visits, RPM, and other telehealth modalities to manage patients with chronic diseases. The speakers cover:
Bringing the Team to the Video Visit: Best Practices and Practical Solutions
Make telemedicine more satisfying and effective for patients and physicians by mobilizing your practice team.
Telemedicine 201 Education Program: Moving Beyond Adoption to Optimal Integration Into Practice
Expand your skills and learn from experienced telemedicine educators in this series of free, one-hour webinars. Webinars will be recorded and reproduced as enduring material on this site after each event. Video Visits Beyond Simple Cases Watch the webinar (in short segments), and access video demonstrations of remote physical exam techniques from Johns Hopkins. Watch Videos
Remote Patient Monitoring | ACP
Patients with chronic medical conditions may benefit from remote patient monitoring. Learn how you can implement remote monitoring of your patients here.
ORCHA’s Assessment Process
Baseline AssessmentThe ORCHA Assessment Development Team have translated the DHAF evaluation criteria into a set of 350 objective questions that trained ORCHA Assessors are looking to answer. Questions are scored, earning the app positive points or negative points depending on the nature of the question and the response. Each Review Domain (set of questions) produces a Domain score. These Review Domain scores are then combined to create an overall DHAF percentage score.
About the Digital Health Assessment Framework (DHAF)
Seeking a common framework for assessing apps.
Library of Digital Health Apps for Patients
Are you keeping up with your patients’ interests in using digital health apps to monitor and manage chronic conditions and health? Recent surveys show 35-40% of adults use phone or tablet apps to manage their health.
Telehealthcare Guidance and Resources | Business Resources | ACP
ACP supports physicians use of telehealth to provide care to their patients from anywhere. Learn if it will work for your practice and the regulations here.
Displaying 441 - 450 of 6848 in Annals of Internal Medicine
These Annals of Internal Medicine results only contain recent articles.
- Visit annals.org to search all content back to 1927.
- View Annals of Internal Medicine CME by topic here.
Mammography Screening Preferences Among Screening-Eligible Women in Their 40s: A National U.S. Survey: Annals of Internal Medicine: Vol 177, No 8
Background: The U.S. Preventive Services Task Force (USPSTF) recently changed its recommendation for mammography screening from informed decision making to biennial screening for women aged 40 to 49 years. Although many women welcome this change, some may prefer not to be screened at age 40 years. Objective: To conduct a national probability-based U.S. survey to investigate breast cancer screening preferences among women aged 39 to 49 years. Design: Pre–post survey with a breast cancer screening decision aid (DA) intervention. (ClinicalTrials.gov: NCT05376241) Setting: Online national U.S. survey. Participants: 495 women aged 39 to 49 years without a history of breast cancer or a known BRCA1/2 gene mutation. Intervention: A mammography screening DA providing information about screening benefits and harms and a personalized breast cancer risk estimate. Measurements: Screening preferences (assessed before and after the DA), 10-year Gail model risk estimate, and whether the information was surprising and different from past messages. Results: Before viewing the DA, 27.0% of participants preferred to delay screening (vs. having mammography at their current age), compared with 38.5% after the DA. There was no increase in the number never wanting mammography (5.4% before the DA vs. 4.3% after the DA). Participants who preferred to delay screening had lower breast cancer risk than those who preferred not to delay. The information about overdiagnosis was surprising for 37.4% of participants versus 27.2% and 22.9% for information about false-positive results and screening benefits, respectively. Limitation: Respondent preferences may have been influenced by the then-current USPSTF guideline. Conclusion: There are women in their 40s who would prefer to have mammography at an older age, especially after being informed of the benefits and harms of screening. Women who wanted to delay screening were at lower breast cancer risk than women who wanted screening at their current age. Many found information about the benefits and harms of mammography surprising. Primary Funding Source: National Cancer Institute.
Efficacy of Voluntary Medical Male Circumcision to Prevent HIV Infection Among Men Who Have Sex With Men: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 177, No 6
Background: Observational studies suggest that voluntary medical male circumcision (VMMC) may lower HIV risk among men who have sex with men (MSM). A randomized controlled trial (RCT) is needed to confirm this. Objective: To assess the efficacy of VMMC in preventing incident HIV infection among MSM. Design: An RCT with up to 12 months of follow-up. (Chinese Clinical Trial Registry: ChiCTR2000039436) Setting: 8 cities in China. Participants: Uncircumcised, HIV-seronegative men aged 18 to 49 years who self-reported predominantly practicing insertive anal intercourse and had 2 or more male sex partners in the past 6 months. Intervention: VMMC. Measurements: Rapid testing for HIV was done at baseline and at 3, 6, 9, and 12 months. Behavioral questionnaires and other tests for sexually transmitted infections were done at baseline, 6 months, and 12 months. The primary outcome was HIV seroconversion using an intention-to-treat analysis. Results: The study enrolled 124 men in the intervention group and 123 in the control group, who contributed 120.7 and 123.1 person-years of observation, respectively. There were 0 seroconversions in the intervention group (0 infections [95% CI, 0.0 to 3.1 infections] per 100 person-years) and 5 seroconversions in the control group (4.1 infections [CI, 1.3 to 9.5 infections] per 100 person-years). The HIV hazard ratio was 0.09 (CI, 0.00 to 0.81; P = 0.029), and the HIV incidence was lower in the intervention group (log-rank P = 0.025). The incidence rates of syphilis, herpes simplex virus type 2, and penile human papillomavirus were not statistically significantly different between the 2 groups. There was no evidence of HIV risk compensation. Limitation: Few HIV seroconversions and limited follow-up period. Conclusion: Among MSM who predominantly practice insertive anal intercourse, VMMC is efficacious in preventing incident HIV infection; MSM should be included in VMMC guidelines. Primary Funding Source: The National Science and Technology Major Project of China.
Reporting Conflicts of Interest and Funding in Health Care Guidelines: The RIGHT-COI&F Checklist
Background: Conflicts of interest (COIs) of contributors to a guideline project and the funding of that project can influence the development of the guideline. Comprehensive reporting of information on COIs and funding is essential for the transparency and credibility of guidelines. Objective: To develop an extension of the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement for the reporting of COIs and funding in policy documents of guideline organizations and in guidelines: the RIGHT-COI&F checklist. Design: The recommendations of the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network were followed. The process consisted of registration of the project and setting up working groups, generation of the initial list of items, achieving consensus on the items, and formulating and testing the final checklist. Setting: International collaboration. Participants: 44 experts. Measurements: Consensus on checklist items. Results: The checklist contains 27 items: 18 about the COIs of contributors and 9 about the funding of the guideline project. Of the 27 items, 16 are labeled as policy related because they address the reporting of COI and funding policies that apply across an organization’s guideline projects. These items should be described ideally in the organization’s policy documents, otherwise in the specific guideline. The remaining 11 items are labeled as implementation related and they address the reporting of COIs and funding of the specific guideline. Limitation: The RIGHT-COI&F checklist requires testing in real-life use. Conclusion: The RIGHT-COI&F checklist can be used to guide the reporting of COIs and funding in guideline development and to assess the completeness of reporting in published guidelines and policy documents. Primary Funding Source: The Fundamental Research Funds for the Central Universities of China.
Management of Inpatient Elevated Blood Pressures: A Systematic Review of Clinical Practice Guidelines: Annals of Internal Medicine: Vol 177, No 4
Background: Management of elevated blood pressure (BP) during hospitalization varies widely, with many hospitalized adults experiencing BPs higher than those recommended for the outpatient setting. Purpose: To systematically identify guidelines on elevated BP management in the hospital. Data Sources: MEDLINE, Guidelines International Network, and specialty society websites from 1 January 2010 to 29 January 2024. Study Selection: Clinical practice guidelines pertaining to BP management for the adult and older adult populations in ambulatory, emergency department, and inpatient settings. Data Extraction: Two authors independently screened articles, assessed quality, and extracted data. Disagreements were resolved via consensus. Recommendations on treatment targets, preferred antihypertensive classes, and follow-up were collected for ambulatory and inpatient settings. Data Synthesis: Fourteen clinical practice guidelines met inclusion criteria (11 were assessed as high-quality per the AGREE II [Appraisal of Guidelines for Research & Evaluation II] instrument), 11 provided broad BP management recommendations, and 1 each was specific to the emergency department setting, older adults, and hypertensive crises. No guidelines provided goals for inpatient BP or recommendations for managing asymptomatic moderately elevated BP in the hospital. Six guidelines defined hypertensive urgency as BP above 180/120 mm Hg, with hypertensive emergencies requiring the addition of target organ damage. Hypertensive emergency recommendations consistently included use of intravenous antihypertensives in intensive care settings. Recommendations for managing hypertensive urgencies were inconsistent, from expert consensus, and focused on the emergency department. Outpatient treatment with oral medications and follow-up in days to weeks were most often advised. In contrast, outpatient BP goals were clearly defined, varying between 130/80 and 140/90 mm Hg. Limitation: Exclusion of non–English-language guidelines and guidelines specific to subpopulations. Conclusion: Despite general consensus on outpatient BP management, guidance on inpatient management of elevated BP without symptoms is lacking, which may contribute to variable practice patterns. Primary Funding Source: National Institute on Aging. (PROSPERO: CRD42023449250)
Displaying 441 - 450 of 3144 in IM Matters
Displaying 441 - 450 of 2393 in ACP Hospitalist
Displaying 441 - 450 of 500 in Annals of Internal Medicine: Clinical Cases
Multisystem Inflammatory Syndrome in Adults (MIS-A) Associated With COVID-19: A Presentation of Mixed Shock | Annals of Internal Medicine: Clinical Cases
Multisystem inflammatory syndrome in adults (MIS-A) is an uncommon hyperinflammatory complication of COVID-19 that carries significant morbidity. MIS-A cases have been published, but details regarding effective treatment strategies are limited. Here, we describe a 33-year-old woman with no medical history who developed mixed distributive and cardiogenic shock from MIS-A 5 weeks after COVID-19 infection. She received anakinra, intravenous immunoglobulin, steroids, and aggressive supportive care including mechanical ventilation, inotropic and vasopressor support, and diuresis. This patient case highlights the importance of early consideration and recognition of MIS-A and treatment of mixed shock in MIS-A.
Isolated Bilateral Adrenal Histoplasmosis With Addisonian Crisis in an Immunocompetent Host | Annals of Internal Medicine: Clinical Cases
Bilateral adrenal histoplasmosis presenting as an adrenal crisis and being the only site of demonstrable disease in an immunocompetent adult is a rare presentation. The adrenal gland is frequently involved in disseminated histoplasmosis but commonly presents as unilateral mass; isolated bilateral involvement in an immunocompetent patient is rare. We describe a patient case of 38-year-old man presenting with epigastric pain, intermittent low-grade fever, nausea and vomiting, skin darkening, generalized weakness, and weight loss for 6 months. Investigations suggested primary adrenal insufficiency. On imaging, patient was found to have bilateral adrenal masses. The histopathological examination revealed Histoplasma species.
An Unusual Case of Malignant Hypertension and Stress Cardiomyopathy | Annals of Internal Medicine: Clinical Cases
A 39-year-old man with chronic hypertension presented with perioperative malignant hypertension while undergoing induction for elective surgery. He was treated with intravenous antihypertensives. He reported several years of episodic chest pain, palpitations, and diaphoresis. Transthoracic echocardiogram demonstrated new-onset cardiomyopathy. Urinary and serum catecholamines were measured and the pattern of catecholamine levels suggested an extra-adrenal source. Computed tomography of the abdomen showed a contrast-enhancing mass in the bladder suspicious for metastatic paraganglioma. The patient had surgical resection with substantial improvement in his hypertension. The presence of labile hypertension and acute cardiomyopathy precipitated by stress should prompt evaluation for a catecholamine-producing tumor and appropriate genetic testing.
Chronic Spontaneous Urticaria Following Pfizer-BioNTech Coronavirus Disease 2019 Messenger RNA Vaccination | Annals of Internal Medicine: Clinical Cases
Since the introduction of coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccines, much attention has been paid to adverse reactions. Numerous cutaneous reactions are described in the literature, but less so about chronic spontaneous urticaria (CSU). CSU is described as recurrent hives with no identifiable trigger, with or without angioedema, which persists for more than 6 weeks. It can be a frustrating diagnosis for physicians and patients alike because of the difficulty in identification and management. The mainstay of CSU treatment is antihistaminergic therapy. In this case, we describe a 35-year-old woman who was newly diagnosed with CSU after receiving the Pfizer-BioNTech COVID-19 mRNA vaccine.
Hyperplastic Polyps Discovered Because of Unprovoked Acute Upper Gastrointestinal Bleeding as an Unusual Presentation of Malignancy | Annals of Internal Medicine: Clinical Cases
Gastric hyperplastic polyps are small (<1 cm), asymptomatic, and found incidentally on esophagogastroduodenoscopy. Patients can present with dyspepsia, abdominal pain, anemia from chronic occult bleeding, and, rarely, acute upper gastrointestinal bleeding. Helicobacter pylori, autoimmune gastritis, and long-term use of proton-pump inhibitors can increase the risk for hyperplastic polyps. Dysplasia and carcinoma in the surrounding gastric mucosa with concomitant hyperplastic polyps can be seen but carcinoma and dysplasia within the hyperplastic polyp itself are extremely rare. We report on a 70-year-old White woman who presented with melena from what appeared to be hyperplastic polyps on esophagogastroduodenoscopy, but pathology reported frank intramucosal adenocarcinoma.