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Displaying 831 - 840 of 7609 in ACP Online
What You May Have Missed in 2024: Part 2
In this episode of Annals On Call, Dr. Centor revisits information included in the Annals of Internal Medicine supplement “What You May Have Missed in 2024.”First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
What You May Have Missed in 2024: Part 1
In this episode of Annals On Call, Dr. Centor revisits information included in the Annals of Internal Medicine supplement “What You May Have Missed in 2024.”First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
What Would You Recommend for This Patient Interested in a Total Knee Joint Arthroplasty? Grand Rounds Discussion From Beth Israel Deaconess Medical Center
Fourteen million people in the United States have symptomatic knee osteoarthritis (OA), a number that is expected to rise with an aging population. Patients with OA can benefit from nonoperative treatment. However, none of these treatments are disease modifying, and many patients eventually require total joint arthroplasty (TJA). The American College of Rheumatology and the American Association of Hip and Knee Surgeons recently issued a guideline on the optimal timing of TJA in patients with symptomatic moderate-to-severe OA for whom nonoperative therapy has been ineffective.
What Internal Medicine Physicians Need to Know About Contraception
Undesired pregnancy has potential negative effects on physical, mental, social, and financial well-being. Yet, internal medicine physicians too often do not consider contraception as a component of routine preventive health care. Contraception gets little, if any, emphasis during internal medicine residency training, and most internal medicine physicians have never prescribed long-acting contraception or inserted an intrauterine device. Many defer discussion of pregnancy intent and contraception to colleagues in obstetrics and gynecology.
Virtual Urgent Care: Artificial Intelligence Versus Physicians
In this episode of Annals On Call, Dr. Centor discusses artificial intelligence–assisted urgent care with Dr. Zehavi Kugler. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Vaccines: Decision Making Amid Conflicting Recommendations
Vaccinations are among the most impactful of all public health interventions—protecting not only the vaccinee but also those around them. When polio vaccines were introduced, people clamored to receive them to avoid polio-related death and disability. Influenza vaccines have prevented countless lost days from school or work, hospitalizations, and deaths. Hepatitis B vaccines can prevent serious complications, including chronic liver damage and hepatocarcinoma. Some deadly infections such as smallpox have been virtually eliminated by vaccines.
Using Stories to Explore Identity and Enhance Well-being
Share your authentic story. Learn how narrative medicine can expand insight, creativity, compassion for self and others, and connection that supports inclusion and a sense of belonging.No MOC points available for this activity.
Uptake of Newer Antibiotics for Resistant Infections
In this episode of Annals On Call, Dr. Centor discusses the uptake of newer antibiotics for difficult-to-treat resistant infections with Dr. Sameer Kadri. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Updating the Information Blocking Rule: Implications for Patients and Physicians
The 21st Century Cures Act sought to leverage electronic health information systems to empower patients as participants in care by promoting access to and sharing of health information—except when release met one of the “exceptions” to “information blocking” provided in regulation. Efforts to avoid prohibited information blocking have resulted in immediate release of medical test results.
Understanding and Addressing Disparities in Diagnosis: Case 2
Understanding and Addressing Disparities in Diagnosis: Case 2 explores a case in the outpatient setting. The case focuses primarily on the difference in appearance of certain conditions on melanotic skin, as well as the differences in treatment some people of color may face as patients due to bias. This module offers both CME and MOC credit free to members and for a small fee to non-members.
Displaying 831 - 840 of 6853 in Annals of Internal Medicine
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Symptom and Viral Rebound in Untreated SARS-CoV-2 Infection
Background: Although symptom and viral rebound have been reported after nirmatrelvir–ritonavir treatment, the trajectories of symptoms and viral load during the natural course of COVID-19 have not been well described. Objective: To characterize symptom and viral rebound in untreated outpatients with mild to moderate COVID-19. Design: Retrospective analysis of participants in a randomized, placebo-controlled trial. (ClinicalTrials.gov: NCT04518410) Setting: Multicenter trial. Patients: 563 participants receiving placebo in the ACTIV-2/A5401 (Adaptive Platform Treatment Trial for Outpatients With COVID-19) platform trial. Measurements: Participants recorded the severity of 13 symptoms daily between days 0 and 28. Nasal swabs were collected for SARS-CoV-2 RNA testing on days 0 to 14, 21, and 28. Symptom rebound was defined as a 4-point increase in total symptom score after improvement any time after study entry. Viral rebound was defined as an increase of at least 0.5 log10 RNA copies/mL from the immediately preceding time point to a viral load of 3.0 log10 copies/mL or higher. High-level viral rebound was defined as an increase of at least 0.5 log10 RNA copies/mL to a viral load of 5.0 log10 copies/mL or higher. Results: Symptom rebound was identified in 26% of participants at a median of 11 days after initial symptom onset. Viral rebound was detected in 31% and high-level viral rebound in 13% of participants. Most symptom and viral rebound events were transient, because 89% of symptom rebound and 95% of viral rebound events occurred at only a single time point before improving. The combination of symptom and high-level viral rebound was observed in 3% of participants. Limitation: A largely unvaccinated population infected with pre-Omicron variants was evaluated. Conclusion: Symptom or viral relapse in the absence of antiviral treatment is common, but the combination of symptom and viral rebound is rare. Primary Funding Source: National Institute of Allergy and Infectious Diseases.
Health Care During Incarceration: A Policy Position Paper From the American College of Physicians
The American College of Physicians (ACP) has a long-standing commitment to improving the health of all Americans and opposes any form of discrimination in the delivery of health care services. ACP is committed to working toward fully understanding and supporting the unique needs of the incarcerated population and eliminating health disparities for these persons. In this position paper, ACP offers recommendations to policymakers and administrators to improve the health and well-being of persons incarcerated in adult correctional facilities.
Relationship Between Clinician Language and the Success of Behavioral Weight Loss Interventions: A Mixed-Methods Cohort Study: Annals of Internal Medicine: Vol 176, No 11
Background: International guidelines recommend that primary care clinicians recognize obesity and offer treatment opportunistically, but there is little evidence on how clinicians can discuss weight and offer treatment in ways that are well received and effective. Objective: To examine relationships between language used in the clinical visit and patient weight loss. Design: Mixed-methods cohort study. Setting: 38 primary care clinics in England participating in the Brief Intervention for Weight Loss trial. Participants: 246 patients with obesity seen by 87 general practitioners randomly sampled from the intervention group of the randomized clinical trial. Measurements: Conversation analysis of recorded discussions between 246 patients with obesity and 87 clinicians regarding referral to a 12-week behavioral weight management program offered as part of the randomized clinical trial. Clinicians’ interactional approaches were identified and their association with patient weight loss at 12 months (primary outcome) was examined. Secondary outcomes included patients’ agreement to attend weight management, attendance, loss of 5% body weight, actions taken to lose weight, and postvisit satisfaction. Results: Three interactional approaches were identified on the basis of clinicians’ linguistic and paralinguistic practices: creating a sense of referrals as “good news” related to the opportunity of the referral (n = 62); “bad news,” focusing on the harms of obesity (n = 82); or neutral (n = 102). Outcome data were missing from 57 participants, so weighted analyses were done to adjust for missingness. Relative to neutral news, good news was associated with increased agreement to attend the program (adjusted risk difference, 0.25 [95% CI, 0.15 to 0.35]), increased attendance (adjusted risk difference, 0.45 [CI, 0.34 to 0.56]), and weight change (adjusted difference, −3.60 [CI, −6.58 to −0.62]). There was no evidence of differences in mean weight change comparing bad and neutral news, and no evidence of differences in patient satisfaction across all 3 approaches. Limitations: Data were audio only, so body language and nonverbal cues could not be assessed. There is potential for selection bias and residual confounding. Conclusion: When raising the topic of excess weight in clinical visits, presenting weight loss treatment as a positive opportunity is associated with greater uptake of treatment and greater weight loss. Primary Funding Source: National Institute for Health and Care Research School for Primary Care Research and the Foundation for the Sociology of Health and Illness.
High- Versus Low-Dose Exercise Therapy for Knee Osteoarthritis: A Randomized Controlled Multicenter Trial: Annals of Internal Medicine: Vol 176, No 2
Background: The benefits of exercise in patients with knee osteoarthritis are well documented, but the optimal exercise dose remains unknown. Objective: To compare high-dose versus low-dose exercise therapy with regard to knee function, pain, and quality of life (QoL) in patients with long-term symptomatic knee osteoarthritis. Design: A Swedish and Norwegian multicenter randomized controlled superiority trial with multiple follow-ups up to 12 months after the intervention. (ClinicalTrials.gov: NCT02024126) Setting: Primary health care facilities. Patients: 189 patients with diagnosed knee osteoarthritis and a history of pain and decreased knee function were assigned to high-dose therapy (n = 98; 11 exercises; 70 to 90 minutes) or low-dose therapy (n = 91; 5 exercises; 20 to 30 minutes). Intervention: Patient-tailored exercise programs according to the principles of medical exercise therapy. Global (aerobic), semiglobal (multisegmental), and local (joint-specific) exercises were performed 3 times a week for 12 weeks under supervision of a physiotherapist. Measurements: The Knee Injury and Osteoarthritis Outcome Score (KOOS) was measured biweekly during the 3-month intervention period and at 6 and 12 months after the intervention. The primary end point was the mean difference in KOOS scores between groups at the end of the intervention (3 months). Secondary outcomes included pain intensity and QoL. The proportion of patients with minimal clinically important changes in primary and secondary outcomes was compared between groups. Results: Both groups improved over time, but there were no benefits of high-dose therapy in most comparisons. One exception was the KOOS score for function in sports and recreation, where high-dose therapy was superior at the end of treatment and at 6-month follow-up. A small benefit in QoL at 6 and 12 months was also observed. Limitation: There was no control group that did not exercise. Conclusion: The results do not support the superiority of high-dose exercise over low-dose exercise for most outcomes. However, small benefits with high-dose exercise were found for knee function in sports and recreation and for QoL. Primary Funding Source: Swedish Rheumatic Fund.
Second-Line Chimeric Antigen Receptor T-Cell Therapy in Diffuse Large B-Cell Lymphoma: A Cost-Effectiveness Analysis: Annals of Internal Medicine: Vol 176, No 12
Background: First-line treatment of diffuse large B-cell lymphoma (DLBCL) achieves durable remission in approximately 60% of patients. In relapsed or refractory disease, only about 20% achieve durable remission with salvage chemoimmunotherapy and consolidative autologous stem cell transplantation (ASCT). The ZUMA-7 (axicabtagene ciloleucel [axi-cel]) and TRANSFORM (lisocabtagene maraleucel [liso-cel]) trials demonstrated superior event-free survival (and, in ZUMA-7, overall survival) in primary-refractory or early-relapsed (high-risk) DLBCL with chimeric antigen receptor T-cell therapy (CAR-T) compared with salvage chemoimmunotherapy and consolidative ASCT; however, list prices for CAR-T exceed $400 000 per infusion. Objective: To determine the cost-effectiveness of second-line CAR-T versus salvage chemoimmunotherapy and consolidative ASCT. Design: State-transition microsimulation model. Data Sources: ZUMA-7, TRANSFORM, other trials, and observational data. Target Population: “High-risk” patients with DLBCL. Time Horizon: Lifetime. Perspective: Health care sector. Intervention: Axi-cel or liso-cel versus ASCT. Outcome Measures: Incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (iNMB) in 2022 U.S. dollars per quality-adjusted life-year (QALY) for a willingness-to-pay (WTP) threshold of $200 000 per QALY. Results of Base-Case Analysis: The increase in median overall survival was 4 months for axi-cel and 1 month for liso-cel. For axi-cel, the ICER was $684 225 per QALY and the iNMB was −$107 642. For liso-cel, the ICER was $1 171 909 per QALY and the iNMB was −$102 477. Results of Sensitivity Analysis: To be cost-effective with a WTP of $200 000, the cost of CAR-T would have to be reduced to $321 123 for axi-cel and $313 730 for liso-cel. Implementation in high-risk patients would increase U.S. health care spending by approximately $6.8 billion over a 5-year period. Limitation: Differences in preinfusion bridging therapies precluded cross-trial comparisons. Conclusion: Neither second-line axi-cel nor liso-cel was cost-effective at a WTP of $200 000 per QALY. Clinical outcomes improved incrementally, but costs of CAR-T must be lowered substantially to enable cost-effectiveness. Primary Funding Source: No research-specific funding.