Search Results for ""
- ACP Online (7462)
- Annals of Internal Medicine (6915)
- ACP Store (240)
- IM Matters (3160)
- ACP Hospitalist (2455)
- Annals of Internal Medicine: Clinical Cases (499)
Displaying 981 - 990 of 7462 in ACP Online
High Value Care Cases 2: The Cost of Care
Are you able to estimate relative costs of care and communicate with patients proactively about cost as a potential barrier to care? Complete these two cases, in which you will practice using tools and resources designed to help you discuss cost of care with your patients and partner with them to address financial barriers to high value care.
High Value Care Cases 1: Eliminating Health Care Waste
Learn the basic steps of ACP’s model for High Value Care in this activity. The first case focuses on how to better understand the benefits, harms, and relative costs of interventions and decreasing or eliminating the interventions that provide no benefits or may be harmful. In case two, you will practice choosing interventions and care settings that maximize benefits, minimize harms, and reduce costs and see examples of how to customize a care plan that incorporates patient values and concerns.
High-Concentration Cannabinoids: Are They Safe?
In this episode of Annals On Call, Dr. Centor discusses currently available evidence about high-concentration cannabis products and mental health outcomes with Drs. Paula Riggs and Jonathan Samet.First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
HFpEF: 5 Pearls Segment
On this episode of Core IM, the team discusses the diagnostic uncertainty around HFpEF, especially as this systemic condition becomes more prevalent with each passing year. In terms of diagnostics the episode will review echo findings, BNP nuances, and utility of advanced testing. It will also review evidence-based treatments for HFpEF.
Hemochromatosis
Hemochromatosis is an inheritable condition that mainly affects White populations of European descent. Most patients remain asymptomatic, but others develop advanced organ damage that reduces quality of life and long-term survival. Arthropathy, diabetes mellitus, cirrhosis, hypogonadotropic hypogonadism, and cardiomyopathy are key clinical manifestations. Primary care and hospital medicine physicians play an essential role in early identification of this disease, which can be accomplished via standard hematologic testing.
Heat-Related Illnesses
Climate change is anticipated to continue to adversely affect public health, with heat stress the predominant threat. Accordingly, heat-related illness is predicted to increase as extremely hot days become more frequent. Heat stroke, the most serious heat-related illness, is a medical emergency that may be fatal if it is not promptly recognized, addressed with early and rapid cooling, and accompanied by multidisciplinary supportive care as clinically indicated.
Health Policy and Advocacy
Join us in learning from guests Dr. Zoe Tseng and Dr. Ankita Sagar about the fundamental importance and role of advocacy and policy work in healthcare. Listen in to learn practical tools and strategies for advocacy at the local, regional, state, and national level, so that you can effectively incorporate this work into your career. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Health Expenditures of Patients With Diabetes After Bariatric Surgery
In this episode of Annals On Call, Dr. Centor discusses health expenditures for patients with diabetes after bariatric surgery with Drs. Matthew Maciejewski and Caroline Sloan.
Handoffs: Contingency Planning
Most trainees receive very little structured feedback on contingency planning and handoffs. This lack of feedback leads to varied quality of handoffs. There is evidence supporting the standardization of handoffs such as the NEJM trial where they provided education and standardized handoffs with I-PASS. There is little information about what to include in the patient summary sections and more specifically how to actually plan for contingencies.
H5N1 Influenza: What Physicians Need to Know
On 6 September 2024, Annals of Internal Medicine and the American College of Physicians assembled experts to discuss the current epidemiology of H5 influenza in the United States, the potential risk to humans, and strategies to mitigate that risk. Annals Deputy Editor Deborah Cotton, MD, MPH, MA, moderated a panel that included Demetre Daskalakis, MD, MPH; Jonathan Runstadler, DVM, PhD, MS; and Shira Doron, MD, MS. Dr. Daskalakis is the Director of the National Center for Immunization and Respiratory Diseases at the CDC, Dr.
Displaying 981 - 990 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.
Major Update 2: Remdesivir for Adults With COVID-19: A Living Systematic Review and Meta-analysis for the American College of Physicians Practice Points
Background: Remdesivir is approved for the treatment of adults hospitalized with COVID-19. Purpose: To update a living review of remdesivir for adults with COVID-19. Data Sources: Several electronic U.S. Food and Drug Administration, company, and journal websites from 1 January 2020 through 19 October 2021. Study Selection: English-language, randomized controlled trials (RCTs) of remdesivir for COVID-19. Data Extraction: One reviewer abstracted, and a second reviewer verified data. The Cochrane Risk of Bias Tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) method were used. Data Synthesis: Since the last update (search date 9 August 2021), 1 new RCT and 1 new subtrial comparing a 10-day course of remdesivir with control (placebo or standard care) were identified. This review summarizes and updates the evidence on the cumulative 5 RCTs and 2 subtrials for this comparison. Our updated results confirm a 10-day course of remdesivir, compared with control, probably results in little to no mortality reduction (5 RCTs). Updated results also confirm that remdesivir probably results in a moderate increase in the proportion of patients recovered by day 29 (4 RCTs) and may reduce time to clinical improvement (2 RCTs) and hospital length of stay (4 RCTs). New RCTs, by increasing the strength of evidence, lead to an updated conclusion that remdesivir probably results in a small reduction in the proportion of patients receiving ventilation or extracorporeal membrane oxygenation at specific follow-up times (4 RCTs). New RCTs also alter the conclusions for harms—remdesivir, compared with control, may lead to a small reduction in serious adverse events but may lead to a small increase in any adverse event. Limitation: The RCTs differed in definitions of COVID-19 severity and outcomes reported. Conclusion: In hospitalized adults with COVID-19, the findings confirm that remdesivir probably results in little to no difference in mortality and increases the proportion of patients recovered. Remdesivir may reduce time to clinical improvement and may lead to small reductions in serious adverse events but may result in a small increase in any adverse event. Primary Funding Source: U.S. Department of Veterans Affairs.
Efficacy and Safety of Dapagliflozin According to Frailty in Heart Failure With Reduced Ejection Fraction: A Post Hoc Analysis of the DAPA-HF Trial: Annals of Internal Medicine: Vol 175, No 6
Background: Frailty may modify the risk−benefit profile of certain treatments, and frail patients may have reduced tolerance to treatments. Objective: To investigate the efficacy of dapagliflozin according to frailty status, using the Rockwood cumulative deficit approach, in DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure). Design: Post hoc analysis of a phase 3 randomized clinical trial. (ClinicalTrials.gov: NCT03036124) Setting: 410 sites in 20 countries. Patients: Patients with symptomatic heart failure (HF) with a left ventricular ejection fraction of 40% or less and elevated natriuretic peptide. Intervention: Addition of once-daily 10 mg of dapagliflozin or placebo to guideline-recommended therapy. Measurements: The primary outcome was worsening HF or cardiovascular death. Results: Of the 4744 patients randomly assigned in DAPA-HF, a frailty index (FI) was calculable in 4742. In total, 2392 patients (50.4%) were in FI class 1 (FI ≤0.210; not frail), 1606 (33.9%) in FI class 2 (FI 0.211 to 0.310; more frail), and 744 (15.7%) in FI class 3 (FI ≥0.311; most frail). The median follow-up time was 18.2 months. Dapagliflozin reduced the risk for worsening HF or cardiovascular death, regardless of FI class. The differences in event rate per 100 person-years for dapagliflozin versus placebo from lowest to highest FI class were −3.5 (95% CI, −5.7 to −1.2), −3.6 (CI, −6.6 to −0.5), and −7.9 (CI, −13.9 to −1.9). Consistent benefits were observed for other clinical events and health status, but the absolute reductions were generally larger in the most frail patients. Study drug discontinuation and serious adverse events were not more frequent with dapagliflozin than placebo, regardless of FI class. Limitation: Enrollment criteria precluded the inclusion of very high-risk patients. Conclusion: Dapagliflozin improved all outcomes examined, regardless of frailty status. However, the absolute reductions were larger in more frail patients. Primary Funding Source: AstraZeneca.
The Underuse of Medicare's Prevention and Coordination Codes in Primary Care: A Cross-Sectional and Modeling Study: Annals of Internal Medicine: Vol 175, No 8
Background: Efforts to better support primary care include the addition of primary care–focused billing codes to the Medicare Physician Fee Schedule (MPFS). Objective: To examine potential and actual use by primary care physicians (PCPs) of the prevention and coordination codes that have been added to the MPFS. Design: Cross-sectional and modeling study. Setting: Nationally representative claims and survey data. Participants: Medicare patients. Measurements: Frequency of use and estimated Medicare revenue involving 34 billing codes representing prevention and coordination services for which PCPs could but do not necessarily bill. Results: Eligibility among Medicare patients for each service ranged from 8.8% to 100%. Among eligible patients, the median use of billing codes was 2.3%, even though PCPs provided code-appropriate services to more patients, for example, to 5.0% to 60.6% of patients eligible for prevention services. If a PCP provided and billed all prevention and coordination services to half of all eligible patients, the PCP could add to the practice's annual revenue $124 435 (interquartile range [IQR], $30 654 to $226 813) for prevention services and $86 082 (IQR, $18 011 to $154 152) for coordination services. Limitation: Service provision based on survey questions may not reflect all billing requirements; revenues do not incorporate the compliance, billing, and opportunity costs that may be incurred when using these codes. Conclusion: Primary care physicians forego considerable amounts of revenue because they infrequently use billing codes for prevention and coordination services despite having eligible patients and providing code-appropriate services to some of those patients. Therefore, creating additional billing codes for distinct activities in the MPFS may not be an effective strategy for supporting primary care. Primary Funding Source: National Institute on Aging.
Race, Genotype, and Azathioprine Discontinuation: A Cohort Study: Annals of Internal Medicine: Vol 175, No 8
Background: Thiopurines are an important class of immunosuppressants despite their risk for hematopoietic toxicity and narrow therapeutic indices. Benign neutropenia related to an ACKR1 variant (rs2814778-CC) is common among persons of African ancestries. Objective: To test whether rs2814778-CC was associated with azathioprine discontinuation attributed to hematopoietic toxicity and lower thiopurine dosing. Design: Retrospective cohort study. Setting: Two tertiary care centers. Patients: Thiopurine users with White or Black race. Measurements: Azathioprine discontinuation attributed to hematopoietic toxicity. Secondary outcomes included weight-adjusted final dose, leukocyte count, and change in leukocyte count. Results: The rate of azathioprine discontinuation attributed to hematopoietic toxicity was 3.92 per 100 person-years among patients with the CC genotype (n = 101) and 1.34 per 100 person-years among those with the TT or TC genotype (n = 1365) (hazard ratio [HR] from competing-risk model, 2.92 [95% CI, 1.57 to 5.41]). The risk remained significant after adjustment for race (HR, 2.61 [CI, 1.01 to 6.71]). The risk associated with race alone (HR, 2.13 [CI, 1.21 to 3.75]) was abrogated by adjustment for genotype (HR, 1.13 [CI, 0.48 to 2.69]). Lower last leukocyte count and lower dosing were significant among patients with the CC genotype. Lower dosing was validated in an external cohort of 94 children of African ancestries prescribed the thiopurine 6-mercaptopurine (6-MP) for acute lymphoblastic leukemia. The CC genotype was independently associated with lower 6-MP dose intensity relative to the target daily dose of 75 mg/m2 (median, 0.83 [IQR, 0.70 to 0.94] for the CC genotype vs. 0.94 [IQR, 0.72 to 1.13] for the TT or TC genotype; P = 0.013). Limitations: Unmeasured confounding; data limited to tertiary centers. Conclusion: Patients with the CC genotype had higher risk for azathioprine discontinuation attributed to hematopoietic toxicity and lower thiopurine doses. Genotype was associated with those risks, even after adjustment for race. Primary Funding Source: National Institutes of Health.