Search Results for ""
- ACP Online (7611)
- Annals of Internal Medicine (6848)
- IM Matters (3144)
- ACP Hospitalist (2393)
- Annals of Internal Medicine: Clinical Cases (500)
- ACP Store (226)
Displaying 571 - 580 of 7611 in ACP Online
Gastroenterology & Hepatology
A collection of gastroenterology and hepatology activities in the Online Learning Center.
Gastroenterological Malignancies
A collection of educational materials in the Online Learning Center.
Foundations of Clinical Practice
A collection of activities in the Online Learning Center.
Evidence-Based Medicine
A collection of activities in the Online Learning Center.
Esophageal Disorders
A collection of educational materials in the Online Learning Center.
Environmental & Occupational Health
A collection of activities in the Online Learning Center.
Endocrinology, Metabolism, & Nutrition
A collection of endocrinology, metabolism, and nutrition activities in the Online Learning Center.
Dyslipidemia
A collection of educational materials in the Online Learning Center.
Diagnostic Testing
A collection of educational materials in the Online Learning Center.
Diagnostic Reasoning, Tools, Techniques
A collection of educational materials in the Online Learning Center.
Displaying 571 - 580 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.
Sodium–Glucose Cotransporter-2 Inhibitors and the Risk for Dialysis and Cardiovascular Disease in Patients With Stage 5 Chronic Kidney Disease
Background: No studies have reported the long-term outcomes of initiating sodium–glucose cotransporter-2 inhibitors (SGLT2is) in patients with estimated glomerular filtration rates less than 20 mL/min/1.73 m2 to predialysis. Objective: To compare the risk for dialysis, cardiovascular events, and death between SGLT2i users and nonusers in patients with type 2 diabetes (T2D) and stage 5 chronic kidney disease (CKD). Design: Target trial emulation study. Setting: Taiwan’s National Health Insurance Research Database (NHIRD). Participants: By applying sequential target trial emulation principle, 23 854 SGLT2i users and 23 892 SGLT2i nonusers were selected from the NHIRD for patients with T2D and stage 5 CKD from 1 May 2016 to 31 October 2021. Measurements: Conditional Cox proportional hazards models were used to compare the risks for dialysis, hospitalization for heart failure, acute myocardial infarction (AMI), diabetic ketoacidosis (DKA), acute kidney injury (AKI), and all-cause mortality between SGLT2i users and nonusers. Results: In the intention-to-treat model, compared with no SGLT2i use, SGLT2i use was associated with lower risks for dialysis (hazard ratio [HR], 0.34 [95% CI, 0.27 to 0.43]), hospitalization for heart failure (HR, 0.80 [CI, 0.73 to 0.86]), AMI (HR, 0.61 [CI, 0.52 to 0.73]), DKA (HR, 0.78 [CI, 0.71 to 0.85]), and AKI (HR, 0.80 [CI, 0.70 to 0.90]), but there was no difference in the risk for all-cause mortality (HR, 1.11 [CI, 0.99 to 1.24]). The Kaplan–Meier curves and subgroup analyses also showed that initiation of an SGLT2i in stage 5 CKD was associated with a lower risk for long-term dialysis than no SGLT2i use. Limitation: This result may not apply to patients without T2D. Conclusion: This emulated target trial showed that SGLT2i use was associated with a lower risk for dialysis, cardiovascular events, DKA, and AKI than no SGLT2i use in patients with T2D and stage 5 CKD. Primary Funding Source: National Health Research Institutes, Taiwan.
Would You Screen This Patient for Cognitive Impairment?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center: Annals of Internal Medicine: Vol 176, No 10
Dementia, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is defined by a significant decline in 1 or more cognitive domains that interferes with a person’s independence in daily activities. Mild cognitive impairment (MCI) differs from dementia in that the impairment is not sufficient to interfere with independence. For the purposes of this discussion, cognitive impairment (CI) includes both dementia and MCI. Various screening tests are available for CI. These tests ask patients to perform a series of tasks that assess 1 or more domains of cognitive function or ask a caregiver to report on the patient’s abilities. A positive result on a screening test does not equate to a diagnosis of CI; rather, it should lead to additional testing to confirm the diagnosis. On review of the evidence, the U.S. Preventive Services Task Force (USPSTF) concluded in 2020 that the evidence was insufficient to assess the balance of benefits and harms of screening for CI in older adults (“I statement”). The USPSTF did clarify that although there is insufficient evidence, there may be important reasons to identify CI. In this article, 2 experts review the available evidence to answer the following questions: What screening tools are available, and how effective are they in identifying patients with CI? What interventions are available for patients found to have CI, to what extent do they improve patient outcomes, and what, if any, negative effects occur? And, would they recommend screening for CI, and why or why not?