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Displaying 841 - 850 of 7609 in ACP Online
Understanding and Addressing Disparities in Diagnosis: Case 1
Understanding and Addressing Disparities in Diagnosis: Case 1 explores a case in the inpatient setting. The case focuses primarily on diagnostic challenges that may arise when physicians work with patients who have limited English proficiency. This module offers both CME and MOC credit free to members and for a small fee to non-members.
Understanding and Addressing Disparities in Diagnosis
Understanding and Addressing Disparities in Diagnosis provides an overview of clinical reasoning processes. It also introduces learners to the concept of unconscious bias and how unconscious biases affect medical diagnostic decision-making process in diagnosis, leading to poorer outcomes for patients. This module offers both CME and MOC credit free to members and for a small fee to non-members.
(Under) Representation Series: Occupational Therapy
Physicians are often attune to the racial/ethnic and gender underrepresentation within medicine, but less so within nursing, and even less in the rehabilitative medicine fields (occupational therapy and physical therapy). According to 2019 data in OT, about 84% of OTs self-identify as non-Hispanic White, and 4% as Black, which is a decrease from 8% over 10 years before in 2004. Only about 10% of OT practitioners, as well as students in the OT assistant, masters, and doctoral programs, self-identify as male.
Type 2 Diabetes
Type 2 diabetes (T2D) is a prevalent disease that increases risk for vascular, renal, and neurologic complications. Prevention and treatment of T2D and its complications are paramount. Many advancements in T2D care have emerged over the past 5 years, including increased understanding of the importance of early intensive glycemic control, mental health, social determinants of health, healthy eating patterns, continuous glucose monitoring, and the benefits of some drugs for preventing cardiorenal disease.
Type 1 Diabetes: Age at Diagnosis
In this episode of Annals On Call, Dr. Centor discusses the diagnosis of type 1 diabetes mellitus in adults with Dr. Michael Fang. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Turning Values into Career Momentum
Make your work “count twice” toward meaningful advancement and fulfillment. Identify personal guiding values and priorities, and translate them into a strategic focus for career advancement. Through the development of a practical action plan, apply intentional methods that align daily professional efforts with long‑term goals.
Travel Medicine
International travel can cause new illness or exacerbate existing conditions. Because primary care providers are frequent sources of health advice to travelers, they should be familiar with destination-specific disease risks, be knowledgeable about travel and routine vaccines, be prepared to prescribe chemoprophylaxis and self-treatment regimens, and be aware of travel medicine resources. Primary care providers should recognize travelers who would benefit from referral to a specialized travel clinic for evaluation.
Trauma-Informed Care Part 2
Resilience is an essential part of human adaptation to challenges. Uncovering and supporting resilience factors must be central in healthcare professionals’ efforts to provide trauma-informed care. The DEI Shift examines why some have even suggested reframing the approach as “resilience-informed care." First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Trauma-Informed Care Part 1
Trauma has an undeniable impact on our patients' health and illness, and resilience is vital to their ability to buffer that trauma. The DEI Shift welcomes Dr. Moira Szilagyi, President of the American Academy of Pediatrics, and Dr.
Transfusion Thresholds in Myocardial Infarction
In this episode of Annals On Call, Dr. Centor discusses transfusion thresholds in persons with myocardial infarction with Drs. Jeffrey Carson and Maria Brooks. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Displaying 841 - 850 of 6853 in Annals of Internal Medicine
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Outpatient Treatment of Confirmed COVID-19: Living, Rapid Practice Points From the American College of Physicians (Version 1)
An update is available for this article. Description: Strategies to manage COVID-19 in the outpatient setting continue to evolve as new data emerge on SARS-CoV-2 variants and the availability of newer treatments. The Scientific Medical Policy Committee (SMPC) of the American College of Physicians (ACP) developed these living, rapid practice points to summarize the best available evidence on the treatment of adults with confirmed COVID-19 in an outpatient setting. These practice points do not evaluate COVID-19 treatments in the inpatient setting or adjunctive COVID-19 treatments in the outpatient setting. Methods: The SMPC developed these living, rapid practice points on the basis of a living, rapid review done by the ACP Center for Evidence Reviews at Cochrane Austria at the University for Continuing Education Krems (Danube University Krems). The SMPC will maintain these practice points as living by monitoring and assessing the impact of new evidence. Practice Point 1: Consider molnupiravir to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 to 7 days of the onset of symptoms and at high risk for progressing to severe disease. Practice Point 2: Consider nirmatrelvir–ritonavir combination therapy to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at high risk for progressing to severe disease. Practice Point 3: Consider remdesivir to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 7 days of the onset of symptoms and at high risk for progressing to severe disease. Practice Point 4: Do not use azithromycin to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. Practice Point 5: Do not use chloroquine or hydroxychloroquine to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. Practice Point 6: Do not use ivermectin to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. Practice Point 7: Do not use nitazoxanide to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. Practice Point 8: Do not use lopinavir–ritonavir combination therapy to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. Practice Point 9: Do not use casirivimab–imdevimab combination therapy to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting unless it is considered effective against a SARS-CoV-2 variant or subvariant locally in circulation. Practice Point 10: Do not use regdanvimab to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting unless it is considered effective against a SARS-CoV-2 variant or subvariant locally in circulation. Practice Point 11: Do not use sotrovimab to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting unless it is considered effective against a SARS-CoV-2 variant or subvariant locally in circulation. Practice Point 12: Do not use convalescent plasma to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. Practice Point 13: Do not use ciclesonide to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting. Practice Point 14: Do not use fluvoxamine to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.
Patient-Reported Outcome Measures in Cardiovascular Disease: An Evidence Map of the Psychometric Properties of Health Status Instruments
Background: Patient-reported outcomes (PROs) are important measures of treatment effect and can be used to inform the approval of cardiovascular drugs and devices by the U.S. Food and Drug Administration (FDA). Purpose: To catalogue the health status patient-reported outcome measures (PROMs) validated in cardiovascular diseases (CVDs), describe their psychometric properties, and assess adherence with both FDA recommendations and the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) framework. Data Sources: MEDLINE, EMBASE, CINAHL, and Allied and Complementary Medicine Database from inception to August 2022. Study Selection: Studies that developed and/or validated health status PROMs in CVD populations. Data Extraction: Two study authors extracted data on CVD type, PROM psychometric properties, and adherence to FDA recommendations. The risk of bias informing the development or validation of PROMs was assessed using the COSMIN framework. Data Synthesis: Fifty health status PROMs (described in 83 studies) were identified, of which 45 were disease specific and 5 were generic. Eleven (22%) of the 50 PROMs validated in CVDs had minimally important differences (MIDs) established, and 8 (16%) reported on the validation of all psychometric properties recommended by the FDA. By COSMIN standards, only 2 PROMs (4%) had all of their psychometric properties rated as sufficient in quality, and 32 PROMs (64%) had less than 50% of psychometric properties rated as sufficient. Limitation: The quality of reporting varied across included studies. Conclusion: Of 50 PROMs validated in CVDs, only a small minority reported on the validation of all FDA-recommended psychometric properties, had psychometric properties rated as sufficient by COSMIN, or had MIDs established. Given the use of PROMs to guide FDA approvals of drugs and devices in CVDs, there is a need for better adherence to quality standards in PROM validation. Primary Funding Source: None.
Estimated Effect of Parathyroidectomy on Long-Term Kidney Function in Adults With Primary Hyperparathyroidism
Background: Multidisciplinary guidelines recommend parathyroidectomy to slow the progression of chronic kidney disease in patients with primary hyperparathyroidism (PHPT) and an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2. Limited data address the effect of parathyroidectomy on long-term kidney function. Objective: To compare the incidence of a sustained decline in eGFR of at least 50% among patients with PHPT treated with parathyroidectomy versus nonoperative management. Design: Target trial emulation was done using observational data from adults with PHPT, using an extended Cox model with time-varying inverse probability weighting. Setting: Veterans Health Administration. Patients: Patients with a new biochemical diagnosis of PHPT in 2000 to 2019. Measurements: Sustained decline of at least 50% from pretreatment eGFR. Results: Among 43 697 patients with PHPT (mean age, 66.8 years), 2928 (6.7%) had a decline of at least 50% in eGFR over a median follow-up of 4.9 years. The weighted cumulative incidence of eGFR decline was 5.1% at 5 years and 10.8% at 10 years in patients managed with parathyroidectomy, compared with 5.1% and 12.0%, respectively, in those managed nonoperatively. The adjusted hazard of eGFR decline did not differ between parathyroidectomy and nonoperative management (hazard ratio [HR], 0.98 [95% CI, 0.82 to 1.16]). Subgroup analyses found no heterogeneity of treatment effect based on pretreatment kidney function. Parathyroidectomy was associated with a reduced hazard of the primary outcome among patients younger than 60 years (HR, 0.75 [CI, 0.59 to 0.93]) that was not evident among those aged 60 years or older (HR, 1.08 [CI, 0.87 to 1.34]). Limitation: Analyses were done in a predominantly male cohort using observational data. Conclusion: Parathyroidectomy had no effect on long-term kidney function in older adults with PHPT. Potential benefits related to kidney function should not be the primary consideration for PHPT treatment decisions. Primary Funding Source: National Institute on Aging.
Risk Model–Based Lung Cancer Screening: A Cost-Effectiveness Analysis: Annals of Internal Medicine: Vol 176, No 3
Background: In their 2021 lung cancer screening recommendation update, the U.S. Preventive Services Task Force (USPSTF) evaluated strategies that select people based on their personal lung cancer risk (risk model–based strategies), highlighting the need for further research on the benefits and harms of risk model–based screening. Objective: To evaluate and compare the cost-effectiveness of risk model–based lung cancer screening strategies versus the USPSTF recommendation and to explore optimal risk thresholds. Design: Comparative modeling analysis. Data Sources: National Lung Screening Trial; Surveillance, Epidemiology, and End Results program; U.S. Smoking History Generator. Target Population: 1960 U.S. birth cohort. Time Horizon: 45 years. Perspective: U.S. health care sector. Intervention: Annual low-dose computed tomography in risk model–based strategies that start screening at age 50 or 55 years, stop screening at age 80 years, with 6-year risk thresholds between 0.5% and 2.2% using the PLCOm2012 model. Outcome Measures: Incremental cost-effectiveness ratio (ICER) and cost-effectiveness efficiency frontier connecting strategies with the highest health benefit at a given cost. Results of Base-Case Analysis: Risk model–based screening strategies were more cost-effective than the USPSTF recommendation and exclusively comprised the cost-effectiveness efficiency frontier. Among the strategies on the efficiency frontier, those with a 6-year risk threshold of 1.2% or greater were cost-effective with an ICER less than $100 000 per quality-adjusted life-year (QALY). Specifically, the strategy with a 1.2% risk threshold had an ICER of $94 659 (model range, $72 639 to $156 774), yielding more QALYs for less cost than the USPSTF recommendation, while having a similar level of screening coverage (person ever-screened 21.7% vs. USPSTF's 22.6%). Results of Sensitivity Analyses: Risk model–based strategies were robustly more cost-effective than the 2021 USPSTF recommendation under varying modeling assumptions. Limitation: Risk models were restricted to age, sex, and smoking-related risk predictors. Conclusion: Risk model–based screening is more cost-effective than the USPSTF recommendation, thus warranting further consideration. Primary Funding Source: National Cancer Institute (NCI).
Outpatient Treatment of Confirmed COVID-19: A Living, Rapid Review for the American College of Physicians
An update is available for this article. This article has been corrected. The original version of the article and supplement (PDF) is appended to this article as a Supplement. Background: Clinicians and patients want to know the benefits and harms of outpatient treatment options for SARS-CoV-2 infection. Purpose: To assess the benefits and harms of 12 different COVID-19 treatments in the outpatient setting. Data Sources: Epistemonikos COVID-19 L·OVE Platform, searched on 4 April 2022. Study Selection: Two reviewers independently screened abstracts and full texts against a priori–defined criteria. Randomized controlled trials (RCTs) that compared COVID-19 treatments in adult outpatients with confirmed SARS-CoV-2 infection were included. Data Extraction: One reviewer extracted data and assessed risk of bias and certainty of evidence (COE). A second reviewer verified data abstraction and assessments. Data Synthesis: The 26 included studies collected data before the emergence of the Omicron variant. Nirmatrelvir–ritonavir and casirivimab–imdevimab probably reduced hospitalizations (1% vs. 6% [1 RCT] and 1% vs. 4% [1 RCT], respectively; moderate COE). Nirmatrelvir–ritonavir probably reduced all-cause mortality (0% vs. 1% [1 RCT]; moderate COE), and regdanvimab probably improved recovery (87% vs. 72% [1 RCT]; moderate COE). Casirivimab–imdevimab reduced time to recovery by a median difference of 4 days (10 vs. 14 median days [1 RCT]; high COE). Molnupiravir may reduce all-cause mortality, sotrovimab and remdesivir may reduce hospitalization, and remdesivir may improve recovery (low COE). Lopinavir–ritonavir and azithromycin may have increased harms, and hydroxychloroquine may result in lower recovery rates (low COE). Other treatments had insufficient evidence or no statistical difference in efficacy and safety versus placebo. Limitation: Many outcomes had few events and small samples. Conclusion: Some antiviral medications and monoclonal antibodies may improve outcomes for outpatients with mild to moderate COVID-19. However, the generalizability of the findings to the currently dominant Omicron variant is limited. Primary Funding Source: American College of Physicians. (PROSPERO: CRD42022323440)
Cold Versus Hot Snare Polypectomy for Small Colorectal Polyps: A Pragmatic Randomized Controlled Trial: Annals of Internal Medicine: Vol 176, No 3
Background: Although cold snare polypectomy (CSP) is considered effective in reducing delayed postpolypectomy bleeding risk, direct evidence supporting its safety in the general population remains lacking. Objective: To clarify whether CSP would reduce delayed bleeding risk after polypectomy compared with hot snare polypectomy (HSP) in the general population. Design: Multicenter randomized controlled study. (ClinicalTrials.gov: NCT03373136) Setting: 6 sites in Taiwan, July 2018 through July 2020. Participants: Participants aged 40 years or older with polyps of 4 to 10 mm. Intervention: CSP or HSP to remove polyps of 4 to 10 mm. Measurements: The primary outcome was the delayed bleeding rate within 14 days after polypectomy. Severe bleeding was defined as a decrease in hemoglobin concentration of 20 g/L or more, requiring transfusion or hemostasis. Secondary outcomes included mean polypectomy time, successful tissue retrieval, en bloc resection, complete histologic resection, and emergency service visits. Results: A total of 4270 participants were randomly assigned (2137 to CSP and 2133 to HSP). Eight patients (0.4%) in the CSP group and 31 (1.5%) in the HSP group had delayed bleeding (risk difference, −1.1% [95% CI, −1.7% to −0.5%]). Severe delayed bleeding was also lower in the CSP group (1 [0.05%] vs. 8 [0.4%] events; risk difference, −0.3% [CI, −0.6% to −0.05%]). Mean polypectomy time (119.0 vs. 162.9 seconds; difference in mean, −44.0 seconds [CI, −53.1 to −34.9 seconds]) was shorter in the CSP group, although successful tissue retrieval, en bloc resection, and complete histologic resection did not differ. The CSP group had fewer emergency service visits than the HSP group (4 [0.2%] vs. 13 [0.6%] visits; risk difference, −0.4% [CI, −0.8% to −0.04%]). Limitation: An open-label, single-blind trial. Conclusion: Compared with HSP, CSP for small colorectal polyps significantly reduces the risk for delayed postpolypectomy bleeding, including severe events. Primary Funding Source: Boston Scientific Corporation.