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Displaying 891 - 900 of 7461 in ACP Online
Postoperative Troponin Elevation
The Annals Consult Guys provide guidance about the measurement and interpretation of high-sensitivity cardiac troponin in the setting of noncardiac surgery.
Postoperative Euglycemic Diabetic Ketoacidosis
The Annals Consult Guys provide a viewer consultation of a patient who developed ketoacidosis after a Whipple procedure.
Post-Kidney Transplant: 5 Pearls Segment
End-stage renal disease affects approximately 500,000 people in the United States. The optimal choice of renal replacement therapy is kidney transplant, as it improves quality of life, morbidity, and mortality. Many health care practitioners may, however, feel uncomfortable with post-kidney transplant care.
Post Disruptive Growth
Explore Post-Disruptive Growth (PDG) as a vital leadership concept for navigating evolving work environments through crises and disruptions . Define PDG, identify when it emerges, and learn to cultivate conditions for healthy growth across individuals, teams, and systems. Through applied exercises, gain the insights needed to foster team stability and lead effectively through constant change.
Physicians with Disabilities: A Conversation with Dr. John Hall
Many Internal Medicine physicians may have limited awareness and understanding of the diverse accommodation needs that physicians and patients with disabilities may require. This gap in knowledge can hinder the creation of inclusive work environments, affect the overall well-being and performance of physicians with disabilities as well as negatively impact the patient-physician relationship.
Physicians Not Providers
In this episode of Annals On Call, Dr. Centor discusses why the American College of Physicians believes that physicians should not be called providers with Drs. Robert McLean and Jan Carney.First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Physician Suicide Prevention: The Ethics and Role of the Physician Colleague and the Healing Community
Suicide is a major health issue that has a tremendous impact on individuals, families, and communities. The medical community is no exception. This ethics case study is intended to raise awareness of stressors and provide guidance. The 2024 rerelease of this ethics case study provides an additional learning and credit earning opportunity for learners who claimed credit for earlier versions.
Perioperative Medicine: 2025 Video Recordings Package
Highly-rated clinician-educators will review the assessment and management of patients with medical comorbidities undergoing noncardiac surgical procedures and discuss preoperative anesthesia essentials, a selection of validated cardiac risk assessment tools, venous thromboembolism prophylaxis in the most frequently performed surgeries, and antiplatelet agent management in patients with cardiac disease undergoing noncardiac surgery. Interspersed between these presentations will be clinical vignettes that complement the presentations and expand the topics discussed.
Perioperative Medicine: 2024 Video Recordings Package
Expert clinician-educators will initially discuss preoperative anesthesia essentials, selection of validated cardiac risk assessment tools, venous thromboembolism prophylaxis in the most frequently performed surgeries, and antiplatelet agent management in patients with cardiac disease undergoing noncardiac surgery. Interspersed between these presentations will be clinical vignettes that complement the presentations and expand the topics discussed. The second phase of the course will be directed at the postoperative issues that face the medical consultants.
Peer Coaching to Support Individuals and Organizations
Identify core coaching skills and ways to leverage them to support a colleague(s) in need. No MOC points available for this activity
Displaying 891 - 900 of 6915 in Annals of Internal Medicine
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Oral ENT-01 Targets Enteric Neurons to Treat Constipation in Parkinson Disease: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 175, No 12
Background: Parkinson disease (PD) is associated with α-synuclein (αS) aggregation within enteric neurons. ENT-01 inhibits the formation of αS aggregates and improved constipation in an open-label study in patients with PD. Objective: To evaluate the safety and efficacy of oral ENT-01 for constipation and neurologic symptoms in patients with PD and constipation. Design: Randomized, placebo-controlled phase 2b study. (ClinicalTrials.gov: NCT03781791) Setting: Outpatient. Patients: 150 patients with PD and constipation. Intervention: ENT-01 or placebo daily for up to 25 days. After baseline assessment of constipation severity, daily dosing was escalated to the prokinetic dose, the maximum dose (250 mg), or the tolerability limit, followed by a washout period. Measurements: The primary efficacy end point was the number of complete spontaneous bowel movements (CSBMs) per week. Neurologic end points included dementia (assessed using the Mini-Mental State Examination [MMSE]) and psychosis (assessed using the Scale for the Assessment of Positive Symptoms adapted for PD [SAPS-PD]). Results: The weekly CSBM rate increased from 0.7 to 3.2 in the ENT-01 group versus 0.7 to 1.2 in the placebo group (P < 0.001). Improvement in secondary end points included SBMs (P = 0.002), stool consistency (P < 0.001), ease of passage (P = 0.006), and laxative use (P = 0.041). In patients with dementia, MMSE scores improved by 3.4 points 6 weeks after treatment in the ENT-01 group (n = 14) versus 2.0 points in the placebo group (n = 14). Among patients with psychosis, SAPS-PD scores improved from 6.5 to 1.7 six weeks after treatment in the ENT-01 group (n = 5) and from 6.3 to 4.4 in the placebo group (n = 6). ENT-01 was well tolerated, with no deaths or drug-related serious adverse events. Adverse events were predominantly gastrointestinal, including nausea (34.4% [ENT-01] vs. 5.3% [placebo]; P < 0.001) and diarrhea (19.4% [ENT-01] vs. 5.3% [placebo]; P = 0.016). Limitation: Longer treatment periods need to be investigated in future studies. Conclusion: ENT-01 was safe and significantly improved constipation. Primary Funding Source: Enterin, Inc.
Monoclonal Antibodies for Treatment of SARS-CoV-2 Infection During Pregnancy: A Cohort Study: Annals of Internal Medicine: Vol 175, No 12
Background: Monoclonal antibody (mAb) treatment decreases hospitalization and death in high-risk outpatients with mild to moderate COVID-19. However, no studies have evaluated adverse events and effectiveness of mAbs in pregnant persons compared with no mAb treatment. Objective: To determine the frequency of drug-related adverse events and obstetric-associated safety outcomes after treatment with mAb compared with no mAb treatment of pregnant persons, and the association between mAb treatment and a composite of 28-day COVID-19–related hospital admission or emergency department (ED) visit, COVID-19–associated delivery, or mortality. Design: Retrospective, propensity score–matched, cohort study. Setting: UPMC Health System from 30 April 2021 to 21 January 2022. Participants: Persons aged 12 years or older with a pregnancy episode and any documented positive SARS-CoV-2 test (polymerase chain reaction or antigen test). Intervention: Bamlanivimab and etesevimab, casirivimab and imdevimab, or sotrovimab treatment compared with no mAb treatment. Measurements: Drug-related adverse events, obstetric-associated safety outcomes among persons who delivered, and a risk-adjusted composite of 28-day COVID-19–related hospital admission or ED visit, COVID-19–associated delivery, or mortality. Results: Among 944 pregnant persons (median age [interquartile range (IQR)], 30 years [26 to 33 years]; White (79.5%; n = 750); median Charlson Comorbidity Index score [IQR], 0 [0 to 0]), 552 received mAb treatment (58%). Median gestational age at COVID-19 diagnosis or treatment was 179 days (IQR, 123 to 227), and most persons received sotrovimab (69%; n = 382). Of those with known vaccination status, 392 (62%) were fully vaccinated. Drug-related adverse events were uncommon (n = 8; 1.4%), and there were no differences in any obstetric-associated outcome among 778 persons who delivered. In the total population, the risk ratio for mAb treatment of the composite 28-day COVID-19–associated outcome was 0.71 (95% CI, 0.37 to 1.4). The propensity score–matched risk ratio was 0.61 (95% CI, 0.34 to 1.1). There were no deaths among mAb-treated patients compared with 1 death in the nontreated control patients. There were more non-COVID-19–related hospital admissions in the mAb-treated persons in the unmatched cohort (14 [2.5%] vs. 2 [0.5%]; risk ratio, 5.0; 95% CI, 1.1 to 21.7); however, there was no difference in the propensity score–matched rates, which were 2.5% mAb-treated vs. 2% untreated (risk ratio, 1.3; 95% CI, 0.58% to 2.8%). Limitations: Drug-related adverse events were patient and provider reported and potentially underrepresented. Symptom severity at the time of SARS-CoV-2 testing was not available for nontreated patients. Conclusion: In pregnant persons with mild to moderate COVID-19, adverse events after mAb treatment were mild and rare. There was no difference in obstetric-associated safety outcomes between mAb treatment and no treatment among persons who delivered. There was no difference in 28-day COVID-19–associated outcomes and non-COVID-19–related hospital admissions for mAb treatment compared with no mAb treatment in a propensity score–matched cohort. Primary Funding Source: No funding was received for this study.
Characteristics of Persons Screened for Lung Cancer in the United States: A Cohort Study: Annals of Internal Medicine: Vol 175, No 11
Background: Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was recommended by the U.S. Preventive Services Task Force (USPSTF) in 2013, making approximately 8 million Americans eligible for screening. The demographic characteristics and adherence of persons screened in the United States have not been reported at the population level. Objective: To define sociodemographic characteristics and adherence among persons screened and entered into the American College of Radiology's Lung Cancer Screening Registry (LCSR). Design: Cohort study. Setting: United States, 2015 to 2019. Participants: Persons receiving a baseline LDCT for LCS from 3625 facilities reporting to the LCSR. Measurements: Age, sex, and smoking status distributions (percentages) were computed among persons who were screened and among respondents in the 2015 National Health Interview Survey (NHIS) who were eligible for screening. The prevalence between the LCSR and the NHIS was compared with prevalence ratios (PRs) and 95% CIs. Adherence to annual screening was defined as having a follow-up test within 11 to 15 months of an initial LDCT. Results: Among 1 159 092 persons who were screened, 90.8% (n = 1 052 591) met the USPSTF eligibility criteria. Compared with adults from the NHIS who met the criteria (n = 1257), screening recipients in the LCSR were older (34.7% vs. 44.8% were aged 65 to 74 years; PR, 1.29 [95% CI, 1.20 to 1.39]), more likely to be female (41.8% vs. 48.1%; PR, 1.15 [CI, 1.08 to 1.23]), and more likely to currently smoke (52.3% vs. 61.4%; PR, 1.17 [CI, 1.11 to 1.23]). Only 22.3% had a repeated annual LDCT. If follow-up was extended to 24 months and more than 24 months, 34.3% and 40.3% were adherent, respectively. Limitations: Underreporting of LCS and missing data may skew demographic characteristics of persons reported to be screened. Underreporting of adherence may result in underestimates of follow-up. Conclusion: Approximately 91% of persons who had LCS met USPSTF eligibility criteria. In addition to continuing to target all eligible adults, men, those who formerly smoked, and younger eligible patients may be less likely to be screened. Adherence to annual follow-up screening was poor, potentially limiting screening effectiveness. Primary Funding Source: None.
Long-Term Stability of Coverage Among Michigan Medicaid Beneficiaries: A Cohort Study: Annals of Internal Medicine: Vol 176, No 1
Background: Medicaid, the primary source of insurance coverage for disadvantaged Americans, was originally designed as a temporary safety-net program. No studies have used long-run data to assess the recent use of the program by beneficiaries. Objective: To assess patterns of short- and long-term enrollment among beneficiaries, using a 10-year longitudinal panel of Michigan Medicaid eligibility data. Design: Primary analyses assessing trends in Medicaid enrollment among cohorts of existing and new beneficiaries. Setting: Administrative records from Michigan Medicaid for the period 2011 to 2020. Participants: 3.97 million Medicaid beneficiaries. Measurements: Short- and long-term enrollment in the program. Results: The sample includes 3.97 million unique beneficiaries enrolled at some point between 2011 and 2020. Among a cohort of 1.23 million beneficiaries enrolled in 2011, over half (53%) were also enrolled in Medicaid in June 2020, spending, on average, two-thirds of that period (67%) on Medicaid. These beneficiaries, however, experienced substantial lapses in coverage, as only 25% were continuously enrolled throughout the period. Enrollment was less stable when assessed from the perspective of newly enrolled beneficiaries, of whom only 37% remained enrolled at the end of the study period. Limitation: Primary estimates from a single state. Conclusion: For many beneficiaries, Medicaid has served as their primary source of coverage for at least a decade. This pattern would justify increasing investments in the program to improve long-term health outcomes. Primary Funding Source: Self-funded.