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Displaying 991 - 1000 of 7462 in ACP Online
Guideline Directed Medical Therapy Part II: 5 Pearls Segment
This episode on Heart Failure with Reduced Ejection Fraction (HFrEF) GDMT (Guideline-directed medical therapy) further expands on the considerations and guidelines for medical management of HFrEF. With the new results from clinical trials and major guideline updates, a detailed explanation is needed to address medications recommended only in specific subsets of patients such as ivabradine or hydralazine and in diverse and commonly encountered circumstances such as heart failure treatment in the setting of chronic kidney disease, inpatient vs. outpatient setting.
Growing Through Adversity: Transforming Medicine Through Times of Change and Uncertainty
Transform medicine from where you are through disruptions and constant change with actionable and timely recommendations for systems, organizations, and individuals.
Gout Diagnosis and Management: What's New?
In this episode of Annals On Call, Dr. Centor discusses the management of gout with Dr. Angelo Gaffo. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Gout
Gout is characterized by deposition of monosodium urate (MSU) crystals in or around joints, tendons, bursae, and other tissues, resulting in painful recurrent flares and tissue damage. Gout is the most common form of inflammatory arthritis, with a prevalence of 5.1% in the United States, affecting 12.1 million adults. When urate levels exceed the limit of solubility (6.8 mg/dL [400 μmol/L]), MSU crystals may form or grow. Gout flares are the result of inflammatory responses to MSU crystals.
Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss in the Absence of Diabetes
In this episode of Annals On Call, Dr. Centor discusses the effectiveness and safety of glucagon-like peptide-1 receptor agonists for weight loss in the absence of diabetes with Ms. Areesha Moiz. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Giant Cell Arteritis
Giant cell arteritis is a relapsing large-vessel vasculitis affecting the aorta and its branches. It is the most common vasculitis in persons 50 years of age and older. Vision loss occurs in 18% of patients and is preventable with prompt recognition, evaluation, and treatment. Large-artery complications include stenosis, aortic aneurysms, or dissections. Glucocorticoid therapy is effective, but nearly 50% of patients experience relapse. Tocilizumab and upadacitinib are efficacious glucocorticoid-sparing therapies.
Geriatrics and Palliative Medicine for Internal Medicine Physicians: 2025 Video Recordings Package
Highly knowledgeable clinician educators will focus on practical, evidence-based strategies that the internal medicine physician can use across care settings to better identify and treat serious and chronic conditions common to older populations, such as cognitive impairment; function assessment, frailty, and falls; depression and anxiety; and hazards of hospitalization.
Geriatrics and Palliative Medicine for Internal Medicine Physicians: 2024 Video Recordings Package
Expert clinician-educations will focus on practical, evidence-based strategies that the internal medicine physician can use across care settings to better identify and treat serious and chronic conditions common to older populations, such as cognitive impairment; function assessment, frailty, and falls; depression and anxiety; and hazards of hospitalization.
Gastroesophageal Reflux Disease
Gastroesophageal reflux disease (GERD) is a condition that occurs when reflux of gastric contents into the esophagus causes symptoms and/or complications. The prevalence of GERD in Western societies has been estimated at 30%, making it one of the most commonly encountered disorders in primary care. The spectrum of GERD includes typical symptoms of esophageal reflux (heartburn and/or regurgitation); esophageal injury (erosive esophagitis; stricture; Barrett esophagus; and, rarely, adenocarcinoma); and extraesophageal symptoms, such as hoarseness and chronic cough.
Gabapentinoids and COPD: Not a Good Mix?
In this episode of Annals On Call, Dr. Centor discusses the association between gabapentinoids and chronic obstructive pulmonary disease with Mr. Rahman and Dr. Renoux. First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.
Displaying 991 - 1000 of 6915 in Annals of Internal Medicine
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Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation: A Decision Analysis: Annals of Internal Medicine: Vol 175, No 9
Background: Left atrial appendage occlusion (LAAO) is a potential alternative to oral anticoagulants in selected patients with atrial fibrillation (AF). Compared with anticoagulants, LAAO decreases major bleeding risk, but there is uncertainty regarding the risk for ischemic stroke compared with anticoagulation. Objective: To determine the optimal strategy for stroke prevention conditional on a patient's individual risks for ischemic stroke and bleeding. Design: Decision analysis with a Markov model. Data Sources: Evidence from the published literature informed model inputs. Target Population: Women and men with nonvalvular AF and without prior stroke. Time Horizon: Lifetime. Perspective: Clinical. Intervention: LAAO versus warfarin or direct oral anticoagulants (DOACs). Outcome Measures: The primary end point was clinical benefit measured in quality-adjusted life-years. Results of Base-Case Analysis: The baseline risks for stroke and bleeding determined whether LAAO was preferred over anticoagulants in patients with AF. The combined risks favored LAAO for higher bleeding risk, but that benefit became less certain at higher stroke risks. For example, at a HAS-BLED score of 5, LAAO was favored in more than 80% of model simulations for CHA2DS2-VASc scores between 2 and 5. The probability of LAAO benefit in QALYs (>80%) at lower bleeding risks (HAS-BLED score of 0 to 1) was limited to patients with lower stroke risks (CHA2DS2-VASc score of 2). Because DOACs carry lower bleeding risks than warfarin, the net benefit of LAAO is less certain than that of DOACs. Results of Sensitivity Analysis: Results were consistent using the ORBIT bleeding score instead of the HAS-BLED score, as well as alternative sources for LAAO clinical effectiveness data. Limitation: Clinical effectiveness data were drawn primarily from studies on the Watchman device. Conclusion: Although LAAO could be an alternative to anticoagulants for stroke prevention in patients with AF and high bleeding risk, the overall benefit from LAAO depends on the combination of stroke and bleeding risks in individual patients. These results suggest the need for a sufficiently low stroke risk for LAAO to be beneficial. The authors believe that these results could improve shared decision making when selecting patients for LAAO. Primary Funding Source: None.
Evolving Practice Choices by Newly Certified and More Senior General Internists: A Cross-Sectional and Panel Comparison: Annals of Internal Medicine: Vol 175, No 7
Background: Hospital medicine has grown as a field. However, no study has examined trends in career choices by internists over the past decade. Objective: To measure changes in practice setting for general internists. Design: Using Medicare fee-for-service claims (2008 to 2018) and data from the American Board of Internal Medicine, practice setting types were measured annually for general internists initially certifying between 1990 and 2017. Setting: General internists (non-subspecializing) treating Medicare fee-for-service beneficiaries. Patients: Medicare fee-for-service beneficiaries aged 65 years and older with at least 20 evaluation and management (E&M) visits annually. Measurements: Practice setting types were defined as hospitalist (>95% inpatient E&M), outpatient only (100% outpatient E&M), or mixed. Results: 67 902 general internists, comprising 80% of all general internists initially certified from 1990 to 2017 (n = 84 581), were studied. From 2008 to 2018, both hospitalists and outpatient-only physicians increased as percentages of general internists (25% to 40% and 23% to 38%, respectively). This was accompanied by a 56% decline in the percentage of mixed-practice physicians (52% to 23%) as these physicians largely migrated to outpatient-only practice. By 2018, 71% of newly certified general internists practiced as hospitalists compared with only 8% practicing as outpatient-only physicians. Most (86% of hospitalists in 2013) had the same practice type 5 years later. This retention rate was similar across early career and more senior physicians (86% and 85% for the 1999 and 2012 initial certification cohorts, respectively) and for the outpatient-only practice type (95%) but was only 57% for the mixed practice type. Limitation: Practice setting measurement relied only on Medicare fee-for-service claims. Conclusion: Newly certified general internists are largely choosing hospital medicine as their career choice whereas more senior physicians increasingly see patients only in the outpatient setting. Primary Funding Source: This study did not receive direct funding.
Characteristics of High-Need, High-Cost Patients: A “Best-Fit” Framework Synthesis: Annals of Internal Medicine: Vol 175, No 12
Background: Accurately identifying high-need, high-cost (HNHC) patients to reduce their preventable or modifiable health care use for their chronic conditions is a priority and a challenge for U.S. policymakers, health care delivery systems, and payers. Purpose: To identify characteristics and criteria to distinguish HNHC patients. Data Sources: Searches of multiple databases and gray literature from 1 January 2000 to 22 January 2022. Study Selection: English-language studies of characteristics and criteria to identify HNHC adult patients, defined as those with high use (emergency department, inpatient, or total services) or high cost. Data Extraction: Independent, dual-review extraction and quality assessment. Data Synthesis: The review included 64 studies comprising multivariate exposure studies (n = 47), cluster analyses (n = 11), and qualitative studies (n = 6). A National Academy of Medicine (NAM) taxonomy was an initial “best-fit” framework for organizing the synthesis of the findings. Patient characteristics associated with being HNHC included number and severity of comorbid conditions and having chronic clinical conditions, particularly heart disease, chronic kidney disease, chronic lung disease, diabetes, cancer, and hypertension. Patients' risk for being HNHC was often amplified by behavioral health conditions and social risk factors. The reviewers revised the NAM taxonomy to create a final framework, adding chronic pain and prior patterns of high health care use as characteristics associated with an increased risk for being HNHC. Limitation: Little evidence distinguished potentially preventable or modifiable health care use from overall use. Conclusion: A combination of characteristics can be useful for identifying HNHC patients. Because of the complexity of their conditions and circumstances, improving their quality of care will likely also require an individualized assessment of care needs and availability of support services. Primary Funding Source: Agency for Healthcare Research and Quality. (PROSPERO: CRD42020161179)