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Displaying 961 - 970 of 7607 in ACP Online
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.
Low-Dose Aspirin and Iron Deficiency Anemia
In this episode of Annals On Call, Dr. Centor discusses the risk for anemia in older patients receiving aspirin for primary prevention with Dr. Zoe McQuilten. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Low-Cost Generic Cardiovascular Drugs
In this episode of Annals On Call, Dr. Centor discusses the availability of recommended cardiovascular drugs in low-cost generic drug programs with Dr. Cynthia Jackevicius. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Lifestyle Recommendations: Can They Really Improve Public Health?
In this episode of Annals On Call, Dr. Centor discusses why guidelines recommending that clinicians advise patients on lifestyle changes may be a questionable approach to improving public health with Dr. Minna Johansson. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Late-Career, Retiring, and Retired Physicians: Paths, Perils, and Possibilities
This educational activity presents retirement planning as a career‑long and life‑long process, rather than a single end‑point decision. Learn the key phases and pathways of retirement planning including an exploration of the perils and possibilities associated with each phase, helping participants anticipate challenges, recognize opportunities, and apply informed approaches that support well‑being, professional fulfillment, and successful transitions over time.
Lack of Control and Physician Burnout
In this episode of Annals On Call, Dr. Centor discusses factors associated with physician burnout with Dr. Christine Sinsky. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Kratom: A Substance Physicians Should Be Aware Of
In this episode of Annals On Call, Dr. Centor discusses kratom and what physicians should know about how patients may be using this substance with Drs. Eileen Barrett and Amanda Collar. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Displaying 961 - 970 of 6853 in Annals of Internal Medicine
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QUAPAS: An Adaptation of the QUADAS-2 Tool to Assess Prognostic Accuracy Studies
Whereas diagnostic tests help detect the cause of signs and symptoms, prognostic tests assist in evaluating the probable course of the disease and future outcome. Studies to evaluate prognostic tests are longitudinal, which introduces sources of bias different from those for diagnostic accuracy studies. At present, systematic reviews of prognostic tests often use the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool to assess risk of bias and applicability of included studies because no equivalent instrument exists for prognostic accuracy studies. QUAPAS (Quality Assessment of Prognostic Accuracy Studies) is an adaptation of QUADAS-2 for prognostic accuracy studies. Questions likely to identify bias were evaluated in parallel and collated from QUIPS (Quality in Prognosis Studies) and PROBAST (Prediction Model Risk of Bias Assessment Tool) and paired to the corresponding question (or domain) in QUADAS-2. A steering group conducted and reviewed 3 rounds of modifications before arriving at the final set of domains and signaling questions. QUAPAS follows the same steps as QUADAS-2: Specify the review question, tailor the tool, draw a flow diagram, judge risk of bias, and identify applicability concerns. Risk of bias is judged across the following 5 domains: participants, index test, outcome, flow and timing, and analysis. Signaling questions assist the final judgment for each domain. Applicability concerns are assessed for the first 4 domains. The authors used QUAPAS in parallel with QUADAS-2 and QUIPS in a systematic review of prognostic accuracy studies. QUAPAS improved the assessment of the flow and timing domain and flagged a study at risk of bias in the new analysis domain. Judgment of risk of bias in the analysis domain was challenging because of sparse reporting of statistical methods.
Preventing Obesity in Midlife Women: A Recommendation From the Women's Preventive Services Initiative
Description: The Women's Preventive Services Initiative (WPSI), a national coalition of women's health professional organizations and patient advocacy representatives, developed a recommendation for counseling midlife women aged 40 to 60 years with normal or overweight body mass index (BMI; 18.5 to 29.9 kg/m2) to maintain weight or limit weight gain to prevent obesity with the long-term goals of optimizing health, function, and well-being. This recommendation is intended to guide clinical practice and coverage of clinical preventive health services for the Health Resources and Services Administration and other stakeholders. Clinicians providing preventive health care to women in primary care settings are the target audience for this recommendation. Methods: The WPSI developed this recommendation after evaluating results of a systematic review of the effectiveness and harms of interventions to prevent weight gain and obesity in women aged 40 to 60 years without obesity. Seven randomized clinical trials including 51 638 participants and using various counseling and behavioral interventions were included. Trials indicated favorable weight changes with interventions that were statistically significantly different from control groups in 4 of 5 trials of counseling, but not in 2 trials of exercise. Few harms were reported. Recommendation: The WPSI recommends counseling midlife women aged 40 to 60 years with normal or overweight BMI (18.5 to 29.9 kg/m2) to maintain weight or limit weight gain to prevent obesity. Counseling may include individualized discussion of healthy eating and physical activity.
U.S. Trends in Registration for Medical Cannabis and Reasons for Use From 2016 to 2020: An Observational Study: Annals of Internal Medicine: Vol 175, No 7
Background: Cannabis policy liberalization has increased cannabis availability for medical or recreational purposes. Up-to-date trends in medical cannabis licensure can inform clinical policy and care. Objective: To describe recent trends in medical cannabis licensure in the United States. Design: Ecological study with repeated measures. Setting: State registry data via state reports and data requests on medical cannabis licensure from 2016 to 2020. Participants: Medical cannabis patients (persons with medical cannabis licenses) in the United States. Measurements: Total patient volume, patients per 10 000 of total population, and patient-reported qualifying conditions (that is, symptoms or conditions qualifying patients for licensure)—including whether these symptoms align with current therapeutic evidence of cannabis–cannabinoid efficacy. Results: In 2020, 26 states and Washington, DC reported patient numbers, and 19 states reported patient-reported qualifying conditions. Total enrolled patients increased approximately 4.5-fold from 678 408 in 2016 to 2 974 433 in 2020. Patients per 10 000 total population generally increased from 2016 to 2020, most dramatically in Oklahoma (927.1 patients per 10 000 population). However, enrollment increased in states without recreational legalization (that is, medical-only states), whereas enrollment decreased in 5 of 7 with recreational legalization (that is, recreational states). In 2020, 68.2% of patient-reported qualifying conditions had substantial or conclusive evidence of therapeutic value versus 84.6% in 2016. Chronic pain was the most common patient-reported qualifying condition in 2020 (60.6%), followed by posttraumatic stress disorder (10.6%). Limitation: Missing state data; lack of rationale for discontinuing medical cannabis licensure. Conclusion: Enrollment in medical cannabis programs approximately increased 4.5-fold from 2016 to 2020, although enrollment decreased in recreational states. Use for conditions or symptoms without a strong evidence basis increased from 15.4% (2016) to 31.8% (2020). Thoughtful regulatory and clinical strategies are needed to effectively manage this rapidly changing landscape. Primary Funding Source: National Institute on Drug Abuse of the National Institutes of Health.
Comparing Racial Differences in Emphysema Prevalence Among Adults With Normal Spirometry: A Secondary Data Analysis of the CARDIA Lung Study
Background: Computed tomography (CT) imaging complements spirometry and may provide insight into racial disparities in respiratory health. Objective: To determine the difference in emphysema prevalence between Black and White adults with different measures of normal spirometry results. Design: Observational study using clinical data and spirometry from the CARDIA (Coronary Artery Risk Development in Young Adults) study obtained in 2015 to 2016 and CT scans done in 2010 to 2011. Setting: 4 U.S. centers. Participants: Population-based sample of Black and White adults. Measurements: Self-identified race and visually identified emphysema on CT in participants with different measures of “normal” spirometry results, calculated using standard race-specific and race-neutral reference equations. Results: A total of 2674 participants (485 Black men, 762 Black women, 659 White men, and 768 White women) had both a CT scan and spirometry available for analysis. Among participants with a race-specific FEV1 between 80% and 99% of predicted, 6.5% had emphysema. In this group, emphysema prevalence was 3.9-fold (95% CI, 2.1- to 7.1-fold; 15.5% vs. 4.0%) higher among Black men than White men and 1.9-fold (CI, 1.0- to 3.8-fold; 6.6% vs. 3.4%) higher among Black women than White women. Among participants with a race-specific FEV1 between 100% and 120% of predicted, 4.0% had emphysema. In this category, Black men had a 6.4-fold (CI, 2.2- to 18.7-fold; 13.9% vs. 2.2%) higher prevalence of emphysema than White men, whereas Black and White women had a similar prevalence of emphysema (2.6% and 2.0%, respectively). The use of race-neutral equations to identify participants with an FEV1 percent predicted between 80% and 120% attenuated racial differences in emphysema prevalence among men and eliminated racial differences among women. Limitation: No CT scans were obtained during the most recent study visit (2015 to 2016) when spirometry was done. Conclusion: Emphysema is often present before spirometry findings become abnormal, particularly among Black men. Reliance on spirometry alone to differentiate lung health from lung disease may result in the underrecognition of impaired respiratory health and exacerbate racial disparities. Primary Funding Source: National Institutes of Health.
Comparison of SARS-CoV-2 Reverse Transcriptase Polymerase Chain Reaction and BinaxNOW Rapid Antigen Tests at a Community Site During an Omicron Surge: A Cross-Sectional Study: Annals of Internal Medicine: Vol 175, No 5
Background: SARS-CoV-2 rapid antigen tests are an important public health tool. Objective: To evaluate field performance of the BinaxNOW rapid antigen test (Abbott) compared with reverse transcriptase polymerase chain reaction (RT-PCR) for detecting infection with the Omicron variant of SARS-CoV-2. Design: Cross-sectional surveillance study. Setting: Free, walk-up, outdoor, urban community testing and vaccine site led by Unidos en Salud, serving a predominantly Latinx community highly impacted by COVID-19. Participants: Persons seeking COVID-19 testing in January 2022. Measurements: Simultaneous BinaxNOW and RT-PCR from nasal, cheek, and throat swabs, including cycle threshold (Ct) measures; a lower Ct value is a surrogate for higher amounts of virus. Results: Among 731 persons tested with nasal swabs, there were 296 (40.5%) positive results on RT-PCR; 98.9% were the Omicron variant. BinaxNOW detected 95.2% (95% CI, 91% to 98%) of persons who tested positive on RT-PCR with a Ct value below 30, 82.1% (CI, 77% to 87%) of those who tested positive on RT-PCR with a Ct value below 35, and 65.2% (CI, 60% to 71%) of all who were positive on RT-PCR. Among 75 persons with simultaneous nasal and cheek swabs, BinaxNOW using a cheek swab failed to detect 91% (20 of 22) of specimens that were positive on BinaxNOW with a nasal swab. Among persons with simultaneous nasal and throat swabs who were positive on RT-PCR with a Ct value below 30, 42 of 49 (85.7%) were detected by nasal BinaxNOW, 23 of 49 (46.9%) by throat BinaxNOW, and 44 of 49 (89.8%) by either. Limitation: Participants were a cross-sectional sample from a community-based sentinel surveillance site, precluding study of viral or symptom dynamics. Conclusion: BinaxNOW detected persons with high SARS-CoV-2 levels during the Omicron surge, enabling rapid responses to positive test results. Cheek or throat swabs should not replace nasal swabs. As currently recommended, high-risk persons with an initial negative BinaxNOW result should have repeated testing. Primary Funding Source: University of California, San Francisco.
Preventing Obesity in Midlife Women: A Systematic Review for the Women's Preventive Services Initiative
Background: Despite high prevalence rates of obesity in the United States, no clinical guidelines exist for obesity prevention in midlife women who commonly experience weight gain. Purpose: To evaluate evidence on the effectiveness and harms of behavioral interventions to reduce weight gain and improve health outcomes for women aged 40 to 60 years without obesity. Data Sources: English-language searches of Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (inception to 26 October 2021); ClinicalTrials.gov (October 2021); and reference lists of studies and reviews. Study Selection: Randomized controlled trials (RCTs) enrolling predominantly midlife women comparing behavioral interventions to prevent weight gain with control groups and reporting health outcomes and potential harms. Data Extraction: Dual extraction and quality assessment of individual studies. Data Synthesis: Seven RCTs in 12 publications (n = 51 638) were included. Four RCTs showed statistically significant favorable differences in weight change for counseling interventions versus control groups (mean difference of weight change, −0.87 to −2.5 kg), whereas 1 trial of counseling and 2 trials of exercise showed no differences; 1 of 2 RCTs reported improved quality-of-life measures. Interventions did not increase measures of depression or stress in 1 trial; self-reported falls (37% vs. 29%; P < 0.001) and injuries (19% vs. 14%; P = 0.03) were higher with exercise counseling in 1 trial. Limitation: Trials were generally small, heterogeneous, and lacked data on harms, long-term health outcomes, and specific patient populations. Conclusion: Counseling interventions to prevent weight gain in women during midlife may result in modest differences in weight change without causing important harms. More research is needed to determine optimal content, frequency, length, and number of sessions required and should include additional patient populations. Primary Funding Source: Health Resources and Services Administration.