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Displaying 921 - 930 of 7461 in ACP Online
Managing Hyponatremia Part 1
In this episode of Annals On Call, Dr. Centor discusses hyponatremia in the outpatient setting with Dr. Joel Topf.First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Management of Sepsis in Hospitalized Patients
Sepsis is the leading cause of death worldwide. Mortality has improved in the past few decades but remains high, and survivors frequently have long-term complications. Initial diagnostic evaluation focuses on risk stratification and source and pathogen identification. Treatment includes intravenous fluids, vasopressors, steroids if shock is present, antimicrobial therapy targeting the most likely source of infection, and source control. Patients with shock or high-risk organ failure syndromes should be admitted early to an intensive care unit.
Management of Inpatient Hypertension
In this episode of Annals On Call, Dr. Centor discusses the management of hypertension in the hospital with Ms. Linnea Wilson and Dr. Timothy Anderson. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Management of Hyperglycemia in Hospitalized Patients
People with diabetes account for 25% of hospitalizations, or 8 million admissions annually. Poor glycemic control in the hospital is associated with increased morbidity, mortality, length of stay, and readmissions. Key considerations of inpatient diabetes management include initiation of appropriate insulin or medication regimens and frequent dose adjustments based on patient-specific factors. Inpatient diabetes management teams and new technologies are increasingly prevalent and can assist in achieving glycemic targets in the hospital.
Management of Heart Failure in Hospitalized Patients
Heart failure affects more than 6 million people in the United States, and hospitalizations for decompensated heart failure confer a heavy toll in morbidity, mortality, and health care costs. Clinical trials have demonstrated effective interventions; however, hospitalization and mortality rates remain high. Key components of effective hospital care include appropriate diagnostic evaluation, triage and risk stratification, early implementation of guideline-directed medical therapy, adequate diuresis, and appropriate discharge planning.
Management of Dual-Antiplatelet Therapy in a Patient Undergoing Colonoscopy
The Annals Consult Guys discuss the pericolonoscopy management of a patient on dual-antiplatelet therapy and oral anticoagulation following percutaneous transluminal coronary angioplasty (PTCA) with placement of a drug-eluting stent.
Malaria in the United States
In this episode of Annals On Call, Dr. Centor discusses malaria with Drs. Davidson Hamer and Ralph Huits. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Lyme Disease
Lyme disease, caused by Borrelia burgdorferi, is the most common vector-borne disease in the United States, and the range of its tick vector continues to expand. Most Lyme disease cases are diagnosed with the onset of the erythema migrans rashes, which can be single or multiple and vary from a homogeneous erythema to bull’s-eye patterns. Serologic antibody testing is of low sensitivity at onset but becomes highly sensitive after a few weeks. Early dissemination may lead to neurologic and cardiac complications. Mono- or oligoarticular arthritis may develop in untreated patients.
Lp(a) and ASCVD Risk: 5 Pearls Segment
Lp(a) is an established, genetically-determined, independent risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis. Despite the prevalence of elevated Lp(a) and known evidence for its association with ASCVD risk, testing for Lp(a) remains low and may be clinically underutilized for risk stratification in cardiovascular disease.
Low-Dose Colchicine and Incident Knee and Hip Replacements
In this episode of Annals On Call, Dr. Centor discusses the incidence of knee and hip replacements in patients receiving low-dose colchicine with Dr. Tuhina Neogi. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Displaying 921 - 930 of 6915 in Annals of Internal Medicine
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Comparison of Rapid Antigen Tests' Performance Between Delta and Omicron Variants of SARS-CoV-2: A Secondary Analysis From a Serial Home Self-testing Study: Annals of Internal Medicine: Vol 175, No 12
Background: It is important to document the performance of rapid antigen tests (Ag-RDTs) in detecting SARS-CoV-2 variants. Objective: To compare the performance of Ag-RDTs in detecting the Delta (B.1.617.2) and Omicron (B.1.1.529) variants of SARS-CoV-2. Design: Secondary analysis of a prospective cohort study that enrolled participants between 18 October 2021 and 24 January 2022. Participants did Ag-RDTs and collected samples for reverse transcriptase polymerase chain reaction (RT-PCR) testing every 48 hours for 15 days. Setting: The parent study enrolled participants throughout the mainland United States through a digital platform. All participants self-collected anterior nasal swabs for rapid antigen testing and RT-PCR testing. All Ag-RDTs were completed at home, whereas nasal swabs for RT-PCR were shipped to a central laboratory. Participants: Of 7349 participants enrolled in the parent study, 5779 asymptomatic persons who tested negative for SARS-CoV-2 on day 1 of the study were eligible for this substudy. Measurements: Sensitivity of Ag-RDTs on the same day as the first positive (index) RT-PCR result and 48 hours after the first positive RT-PCR result. Results: A total of 207 participants were positive on RT-PCR (58 Delta, 149 Omicron). Differences in sensitivity between variants were not statistically significant (same day: Delta, 15.5% [95% CI, 6.2% to 24.8%] vs. Omicron, 22.1% [CI, 15.5% to 28.8%]; at 48 hours: Delta, 44.8% [CI, 32.0% to 57.6%] vs. Omicron, 49.7% [CI, 41.6% to 57.6%]). Among 109 participants who had RT-PCR–positive results for 48 hours, rapid antigen sensitivity did not differ significantly between Delta- and Omicron-infected participants (48-hour sensitivity: Delta, 81.5% [CI, 66.8% to 96.1%] vs. Omicron, 78.0% [CI, 69.1% to 87.0%]). Only 7.2% of the 69 participants with RT-PCR–positive results for shorter than 48 hours tested positive by Ag-RDT within 1 week; those with Delta infections remained consistently negative on Ag-RDTs. Limitation: A testing frequency of 48 hours does not allow a finer temporal resolution of the analysis of test performance, and the results of Ag-RDTs are based on self-report. Conclusion: The performance of Ag-RDTs in persons infected with the SARS-CoV-2 Omicron variant is not inferior to that in persons with Delta infections. Serial testing improved the sensitivity of Ag-RDTs for both variants. The performance of rapid antigen testing varies on the basis of duration of RT-PCR positivity. Primary Funding Source: National Heart, Lung, and Blood Institute of the National Institutes of Health.
Ethical Considerations in Precision Medicine and Genetic Testing in Internal Medicine Practice: A Position Paper From the American College of Physicians
This American College of Physicians position paper aims to inform ethical decision making for the integration of precision medicine and genetic testing into clinical care. Although the positions are primarily intended for practicing physicians, they may apply to other health care professionals and can also inform how health care systems, professional schools, and residency programs integrate genomics into educational and clinical settings. Addressing the challenges of precision medicine and genetic testing will guide ethical and responsible implementation to improve health outcomes.
Periconception Red Blood Cell Folate and Offspring Congenital Heart Disease: Nested Case–Control and Mendelian Randomization Studies: Annals of Internal Medicine: Vol 175, No 9
Background: Periconception folic acid supplementation has been suggested to protect against congenital heart disease (CHD), but the association between maternal red blood cell (RBC) folate, the gold-standard biomarker of folate exposure, and subsequent offspring CHD risk is lacking. Objective: To quantify the association between periconception maternal RBC folate and offspring CHD risk. Design: Prospective, nested, case–control study and 1-sample Mendelian randomization. (ClinicalTrials.gov: NCT02737644) Setting: 29 maternity institutions in 12 districts of Greater Shanghai, China. Participants: All 197 mothers of offspring with CHD and 788 individually matched mothers of unaffected offspring from the SPCC (Shanghai Preconception Cohort). Measurements: Maternal RBC folate was measured before or at early pregnancy. Odds ratios [ORs] were estimated using conditional logistic regression after adjustment for covariates. Mendelian randomization was done using the methylenetetrahydrofolate reductase (MTHFR) C677T as the genetic instrument. Results: Case patients had lower median maternal RBC folate concentrations than control participants (714 nmol/L [interquartile range, 482 to 1008 nmol/L] vs. 788 nmol/L [557 to 1094 nmol/L]). Maternal RBC folate concentrations were inversely associated with offspring CHD (adjusted OR per 100 nmol/L, 0.93 [95% CI, 0.89 to 0.99]). The adjusted OR for mothers with periconception RBC folate of 906 nmol/L or more (vs. <906 nmol/L) was 0.61 (CI, 0.40 to 0.93). Mendelian randomization showed that each 100-nmol increase in maternal RBC folate concentrations was significantly associated with reduced offspring CHD risk (OR, 0.75 [CI, 0.61 to 0.92]). Limitation: Potential confounding due to unmeasured covariates in the nested case–control study. Conclusion: Higher maternal RBC folate is associated with reduced offspring CHD risk. For primary CHD prevention, higher target RBC folate levels than currently recommended for neural tube defect prevention may be needed and warrant further study. Primary Funding Source: National Key Research and Development Program of China, National Natural Science Foundation of China, China Postdoctoral Science Foundation, and Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences.
Telehealth Strategies for the Delivery of Maternal Health Care: A Rapid Review: Annals of Internal Medicine: Vol 175, No 9
Background: Telehealth strategies to supplement or replace in-person maternity care may affect maternal health outcomes. Purpose: To conduct a rapid review of the effectiveness and harms of telehealth strategies for maternal health care given the recent expansion of telehealth arising from the COVID-19 pandemic, and to produce an evidence map. Data Sources: Systematic searches of MEDLINE, the Cochrane Library, CINAHL, Embase, and Scopus for English-language studies (January 2015 to April 2022). Study Selection: Randomized controlled trials (RCTs) and observational studies of maternal care telehealth strategies versus usual care. Data Extraction: Dual data extraction and risk-of-bias assessment of studies, with disagreements resolved through consensus. Data Synthesis: 28 RCTs and 14 observational studies (n = 44 894) were included. Maternal telehealth interventions supplemented in-person care for most studies of mental health and diabetes during pregnancy, primarily resulting in similar, and sometimes better, clinical and patient-reported outcomes versus usual care. Supplementing in-person mental health care with phone- or web-based platforms or mobile applications resulted in similar or better mental health outcomes versus in-person care. A reduced-visit prenatal care schedule using telehealth to replace in-person general maternity care for low-risk pregnancies resulted in similar clinical outcomes and higher patient satisfaction versus usual care. Overall, telehealth strategies were heterogeneous and resulted in similar obstetric and patient satisfaction outcomes. Few studies addressed disparities, health equity, or harms. Limitations: Interventions varied, and evidence was inadequate for some clinical outcomes. Conclusion: Replacing or supplementing in-person maternal care with telehealth generally results in similar, and sometimes better, clinical outcomes and patient satisfaction compared with in-person care. The effect on access to care, health equity, and harms is unclear. Primary Funding Source: Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42021276347)
Effect of Molnupiravir on Biomarkers, Respiratory Interventions, and Medical Services in COVID-19: A Randomized, Placebo-Controlled Trial: Annals of Internal Medicine: Vol 175, No 8
Background: In the MOVe-OUT trial, molnupiravir showed a clinically meaningful reduction in the risk for hospitalization or death in adults with mild to moderate COVID-19 and risk factors for progression to severe disease. Objective: To identify other potential clinical benefits of molnupiravir versus placebo. Design: Secondary analysis of the randomized, double-blind, placebo-controlled phase 3 component of MOVe-OUT. (ClinicalTrials.gov: NCT04575597) Setting: 107 sites globally. Participants: 1433 nonhospitalized adults aged 18 years or older with mild to moderate COVID-19. Intervention: Molnupiravir, 800 mg, or placebo every 12 hours for 5 days. Measurements: Changes from baseline in C-reactive protein (CRP) concentration and oxygen saturation (Spo 2), need for respiratory interventions (including invasive mechanical ventilation), and need for medical services in all randomly assigned participants through day 29, and need for respiratory interventions and time to discharge in the subgroup of participants who were hospitalized after randomization. Results: Participants receiving molnupiravir showed faster normalization of CRP and Spo 2, with improvements observed on day 3 of therapy, compared with placebo. Molnupiravir-treated participants had a decreased need for respiratory interventions versus placebo-treated participants (relative risk reduction [RRR], 34.3% [95% CI, 4.3% to 54.9%]), with similar findings in participants who were hospitalized after randomization (RRR, 21.3% [CI, 0.2% to 38.0%]). Hospitalized participants who received molnupiravir were discharged a median of 3 days before those who received placebo. Acute care visits (7.2% vs. 10.6%; RRR, 32.1% [CI, 4.4% to 51.7%]) and COVID-19–related acute care visits (6.6% vs. 10.0%; RRR, 33.8% [CI, 5.6% to 53.6%]) were less frequent in molnupiravir- versus placebo-treated participants. Limitations: Some analyses were performed post hoc. Longer-term benefits of molnupiravir therapy were not evaluated. Participants were not immunized against SARS-CoV-2. Conclusion: The findings suggest there are additional important clinical benefits of molnupiravir beyond reduction in hospitalization or death. Primary Funding Source: Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc.