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Displaying 971 - 980 of 7510 in ACP Online
Iron Deficiency Anemia
Iron deficiency anemia (IDA) is caused by iron deficiency, a common yet underrecognized clinical entity. Populations at greatest risk include children, menstruating and pregnant persons, and people of low socioeconomic status. Timely diagnosis and management of iron deficiency are key to preventing IDA and require thorough assessment of the underlying cause and appropriate iron repletion through either oral or parenteral therapy.
Invasive Fungal Diseases: 5 Pearls Segment
Invasive fungal diseases are increasingly common but often under-recognized due to outdated risk frameworks, misinterpretation of diagnostic tests, and unfamiliarity with antifungal therapies. Many clinicians struggle to appropriately identify at-risk patients, interpret fungal markers like Beta-D-Glucan and galactomannan, and initiate timely antifungal treatment. This podcast addresses these gaps by providing practical strategies for risk assessment, diagnostic testing, and evidence-based management of fungal infections.
Intimate Partner Violence: Educating and Connecting
When, where, and how you ask about intimate partner violence matter. In this interactive course, the second in a two-part series, you will learn universal education approaches that both promote prevention and improve health and safety outcomes. Audio Version Now Available Modules and CME/MOC credit are free to ACP Members. Nonmembers may purchase access to claim CME/MOC credit for each module for $25. Copyright 2022 American College of Physicians. All Rights Reserved.
Intimate Partner Violence: Dynamics and Effects
Gain the strategies you need to effectively care for your patients affected by intimate partner violence (IPV) and exploitation. This interactive online activity explores the dynamics and effects of IPV and offers evidence-backed approaches for effective prevention and response. See part two of this series for more practical tips and universal education approaches to prevent IPV and improve health outcomes.
Improving Research Reports: Avoiding P Values
In this episode of Annals On Call, Dr. Centor discusses how to go beyond statistical significance testing when interpreting study findings with Dr. David Savitz. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Immune-Related Adverse Events of Immune Checkpoint Inhibitors
Immune-related adverse events (irAEs) are toxicities that arise after the administration of monoclonal antibodies targeting immune checkpoints (immune checkpoint inhibitors [ICIs]) in patients with cancer. They can occur at any time after initiation of ICI treatment, with a broad clinical phenotype that can be organ-specific or systemic. Although most irAEs manifest as mild to moderate signs and symptoms, severe forms of irAEs can lead to irreversible organ failure and have acute life-threatening presentations. Treatment should be tailored to the specific organ involved and the severity.
Immune Checkpoint Inhibitor Adverse Events 2.0: 5 Pearls Segment
Although internal medicine providers are familiar with checkpoint inhibitors and their immune-related adverse events (IRAE), there is a gap in the knowledge of specific characteristics of these drugs. They are clinically relevant because their adverse events can present similar to other medical conditions and a high degree of suspicion is needed to identify IRAEs.
ILD and High-Risk Medication Prescribing: Gray Matters Segment
Many clinicians lack familiarity with the diagnostic nuances and management strategies for interstitial lung disease (ILD), particularly in distinguishing subtypes (e.g., UIP vs. NSIP) and selecting appropriate treatment options, such as antifibrotics for fibrosing ILDs and avoiding immunosuppressants in idiopathic pulmonary fibrosis (IPF). Additionally, gaps exist in recognizing the role of multidisciplinary care and addressing social determinants of health to improve outcomes.
Hyponatremia Correction: How Fast Is Too Fast?
In this episode of Annals On Call, Dr. Centor discusses hyponatremia correction rates with Dr. Dustin Mark.First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Hyponatremia
Hyponatremia is the most common electrolyte disorder in hospitalized patients. Hospital-associated hyponatremia includes community-acquired (e.g., hyponatremia on admission) and hospital-acquired hyponatremia. Acute-onset hyponatremia requires rapid treatment with hypertonic saline to decrease cerebral edema. In cases of chronic hyponatremia (>48 hours), the brain has time to normalize cell volume by losing solutes. However, even mild chronic cases can have adverse outcomes, such as decreased cognition, osteoporosis, increased risk for falls, and fractures.
Displaying 971 - 980 of 6745 in Annals of Internal Medicine
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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.