Search Results for ""
- ACP Online (7461)
- Annals of Internal Medicine (6915)
- ACP Store (240)
- IM Matters (3160)
- ACP Hospitalist (2455)
- Annals of Internal Medicine: Clinical Cases (499)
Displaying 961 - 970 of 7461 in ACP Online
How Would You Manage This Patient With Type 2 Diabetes and Chronic Kidney Disease? Grand Rounds Discussion From Beth Israel Deaconess Medical Center
Nearly 15% of U.S. adults have diabetes; type 2 diabetes (T2D) accounts for more than 90% of cases. Approximately one third of all patients with diabetes will develop chronic kidney disease (CKD). All patients with T2D should be screened annually for CKD with both a urine albumin–creatinine ratio and an estimated glomerular filtration rate.
How Would You Manage This Patient With Recent-Onset Atrial Fibrillation? Grand Rounds Discussion From Beth Israel Deaconess Medical Center
Atrial fibrillation (AF) is the most common arrhythmia. Risk factors for AF include obstructive sleep apnea, physical inactivity, obesity, cigarette use, and alcohol misuse. Atrial fibrillation substantially increases the risk for stroke and is associated with higher rates of mortality than for individuals without AF. Strategies to prevent these risk factors and to optimize those that already exist reduce the risk for subsequent AF. Physicians play an important role in proposing strategies to reduce the risk for AF among patients.
How Would You Manage This Patient With Obesity? Grand Rounds Discussion From Beth Israel Deaconess Medical Center
In 2022, 1 in 8 people in the world were living with obesity, and lifestyle interventions that include diet, exercise, and behavioral modification have been the foundation for management of obesity. Recently, pharmacologic therapies have been developed for management of obesity, the newest of these being glucagon-like peptide 1 receptor agonists.
How Would You Manage This Patient With Iron Deficiency Anemia? Grand Rounds Discussion From Beth Israel Deaconess Medical Center
Iron deficiency anemia (IDA) is the most common cause of anemia worldwide and a major cause of disability, manifesting with symptoms including fatigue, weakness, exercise intolerance, worsening heart failure, impaired concentration, irritability, and depression. Women of reproductive age are disproportionately affected due to menstrual blood loss and gynecologic disorders. Iron deficiency anemia is diagnosed in patients who have both iron deficiency (ID), noted by low ferritin level and/or transferrin saturation, and anemia.
How Would You Manage This Patient With Idiopathic Acute Pancreatitis? Grand Rounds Discussion From Beth Israel Deaconess Medical Center
Acute pancreatitis is among the most frequent gastroenterologic reasons for hospitalization in the United States. This condition is associated with significant morbidity, including recurrent acute pancreatitis and chronic pancreatitis. Although most patient cases are due to biliary disease and ethanol, approximately 18% are idiopathic. Diagnostic and management options for idiopathic acute pancreatitis include genetic testing for a number of associated mutations and cholecystectomy to treat subclinical or undetected biliary disease.
How Would You Manage This Patient With Heart Failure With Preserved Ejection Fraction? Grand Rounds Discussion From Beth Israel Deaconess Medical Center
The proportion of patients with new-onset heart failure who have preserved rather than reduced left ventricular ejection fraction (HFpEF and HFrEF) has been increasing over recent decades. In fact, HFpEF now outweighs HFrEF as the predominant heart failure subtype and likely remains underdiagnosed in the community. This is due in part to an aging population and a rise in other risk factors for HFpEF, including obesity and associated cardiometabolic disease.
How Would You Manage This Patient With Gastroesophageal Reflux Symptoms? Grand Rounds Discussion From Beth Israel Deaconess Medical Center
Gastroesophageal reflux disease (GERD) is a common medical condition presenting with heartburn, regurgitation, cough, hoarseness, and/or wheezing. Patients with classic GERD symptoms often do not require diagnostic studies before empirical treatment is initiated. However, if atypical features are present, including alarm symptoms for malignancy, or if symptoms do not respond to conventional treatment, upper endoscopy may be necessary. The optimal management of GERD, which is the subject of debate, depends on the frequency and severity of symptoms.
How Would You Manage This Patient With Frequent Migraine Headaches? Grand Rounds Discussion From Beth Israel Deaconess Medical Center
Migraine headaches are highly prevalent and, for women below the age of 50, the leading cause of years lived with disability. Migraines disproportionately affect persons of lower socioeconomic status and those who are uninsured, and they result in millions of office and emergency department visits annually. Migraines are also responsible for billions of dollars in lost productivity and health care expenses each year.
How Would You Manage This Patient With Decreased Bone Density? Grand Rounds Discussion From Beth Israel Deaconess Medical Center
Osteoporosis is a skeletal condition characterized by low bone mass and fragility resulting in an increased risk for fracture. It affects all bones, but fractures most often occur in the hip and spine. Osteoporosis is common in postmenopausal women, with estrogen deficiency thought to be a major contributing factor. Screening for osteoporosis with bone densitometry is recommended in all women 65 years of age or older and in postmenopausal women younger than 65 who are at increased risk.
How Would You Manage This Patient With Clostridioides difficile Infection? Grand Rounds Discussion From Beth Israel Deaconess Medical Center
The Infectious Diseases Society of America/Society for Healthcare Epidemiology of America and the American College of Gastroenterology recently released updated guidelines on management of patients with Clostridioides difficile infection. Although these 2 guidelines generally agree, there are a few important differences in their advice to clinicians.
Displaying 961 - 970 of 6915 in Annals of Internal Medicine
These Annals of Internal Medicine results only contain recent articles.
- Visit annals.org to search all content back to 1927.
- View Annals of Internal Medicine CME by topic here.
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.
Accuracy and Efficiency of Machine Learning–Assisted Risk-of-Bias Assessments in “Real-World” Systematic Reviews: A Noninferiority Randomized Controlled Trial: Annals of Internal Medicine: Vol 175, No 7
Background: Automation is a proposed solution for the increasing difficulty of maintaining up-to-date, high-quality health evidence. Evidence assessing the effectiveness of semiautomated data synthesis, such as risk-of-bias (RoB) assessments, is lacking. Objective: To determine whether RobotReviewer-assisted RoB assessments are noninferior in accuracy and efficiency to assessments conducted with human effort only. Design: Two-group, parallel, noninferiority, randomized trial. (Monash Research Office Project 11256) Setting: Health-focused systematic reviews using Covidence. Participants: Systematic reviewers, who had not previously used RobotReviewer, completing Cochrane RoB assessments between February 2018 and May 2020. Intervention: In the intervention group, reviewers received an RoB form prepopulated by RobotReviewer; in the comparison group, reviewers received a blank form. Studies were assigned in a 1:1 ratio via simple randomization to receive RobotReviewer assistance for either Reviewer 1 or Reviewer 2. Participants were blinded to study allocation before starting work on each RoB form. Measurements: Co-primary outcomes were the accuracy of individual reviewer RoB assessments and the person-time required to complete individual assessments. Domain-level RoB accuracy was a secondary outcome. Results: Of the 15 recruited review teams, 7 completed the trial (145 included studies). Integration of RobotReviewer resulted in noninferior overall RoB assessment accuracy (risk difference, −0.014 [95% CI, −0.093 to 0.065]; intervention group: 88.8% accurate assessments; control group: 90.2% accurate assessments). Data were inconclusive for the person-time outcome (RobotReviewer saved 1.40 minutes [CI, −5.20 to 2.41 minutes]). Limitation: Variability in user behavior and a limited number of assessable reviews led to an imprecise estimate of the time outcome. Conclusion: In health-related systematic reviews, RoB assessments conducted with RobotReviewer assistance are noninferior in accuracy to those conducted without RobotReviewer assistance. Primary Funding Source: University College London and Monash University.
Effect of Social Needs Case Management on Hospital Use Among Adult Medicaid Beneficiaries: A Randomized Study: Annals of Internal Medicine: Vol 175, No 8
Background: Case management programs assisting patients with social needs may improve health and avoid unnecessary health care use, but little is known about their effectiveness. Objective: This large-scale study assessed the population-level impact of a case management program designed to address patients' social needs. Design: Single-site randomized encouragement design with administrative enrollment from an eligible population and intention-to-treat analysis. Study participants were enrolled between August 2017 and December 2018 and followed for 1 year. (ClinicalTrials.gov: NCT04000074) Setting: Contra Costa County, an economically and culturally diverse community in the San Francisco Bay Area. Participants: 57 972 randomized enrollments of adult Medicaid patients at elevated risk for health care use (top 15%) to the intervention or control group. Intervention: Enrollees were offered 12 months of social needs case management, which provided more intensive services to patients with higher demonstrated needs. Measurements: Medical use was measured via emergency department (ED) visits and inpatient admissions, some of which were classified as avoidable. Results: Participants in the intervention group visited the ED at ratios of 0.96 (95% CI, 0.91 to 1.00) for all visits and 0.97 (CI, 0.92 to 1.03) for avoidable visits relative to the control group. The intervention group was hospitalized at ratios of 0.89 (CI, 0.81 to 0.98) for all admissions and 0.72 (CI, 0.55 to 0.88) for avoidable admissions. Limitations: Only 40% of the intervention group engaged with the program. The program was in continual development during the trial period. Conclusion: Although social needs case management programs may reduce health care use, these savings may not cover full program costs. More work is needed to identify ways to increase patient uptake and define characteristics of successful programs. Primary Funding Source: Contra Costa Health Services via the Medicaid waiver program.