Articles tagged with Internal Medicine
TaVNS has shown significant effects in various body systems, reducing depression scores and treating conditions such as migraines, anxiety, cognitive disorders, Parkinson’s disease, and cognitive decline. It has also demonstrated benefits for the cardiovascular system by lowering blood pressure and heart rate.
A randomized clinical trial found that both electronic cigarettes containing nicotine and varenicline were effective for 6-month smoking cessation. The study results suggest a potential new approach to smoking cessation.
A laboratory study found that passive heat exposure stresses the heart, increasing myocardial blood flow in all participants, regardless of age or health status. Adults with a history of CAD are at particular risk and may benefit from minimizing cardiac strain during extreme heat by staying cool.
A 15-day course of nirmatrelvir-ritonavir did not demonstrate a significant improvement in select postacute sequelae of SARS-CoV-2 infection symptoms in vaccinated adults with prolonged symptom duration. Further studies are needed to determine the role of antivirals in PASC treatment.
Early admission of COVID-19-positive patients to skilled nursing facilities was associated with preventable cases and mortality among residents. Facilities with staff and PPE shortages were disproportionately affected, underscoring the importance of adhering to infection-control protocols.
A cost-effectiveness analysis found that first-line MRI-based screening for prostate cancer is less effective and more costly than first-line PSA testing. Despite free MRI costs, the first-line approach resulted in increased false positives and overdiagnosis without substantial reductions in mortality.
The American College of Physicians (ACP) recommends that artificial intelligence (AI) technology should augment physician decision-making, rather than replacing it. ACP advises that AI tools should be designed to enhance human intelligence, prioritize privacy and clinical safety, and reduce disparities in healthcare.
Inflation-adjusted healthcare spending among privately insured US families increased, with low-income families facing a substantial financial medical burden. Financial medical burden was more than 26% of postsubsistence income for low-income families, compared to approximately 6% for higher-income families.
A study found that statin therapy significantly reduces the risk of cardiovascular disease (CVD) and all-cause mortality in adults aged 60 years and older, including those over 85. Statins also did not increase the risk for adverse events such as myopathies and liver dysfunction.
A study of over 75,000 adults found no association between autoimmune diseases and monoclonal gammopathy of undetermined significance (MGUS), suggesting that previous associations may be due to ascertainment bias. The findings have implications for screening recommendations for patients with autoimmune disease.
A new study found that patients prefer professional-looking backdrops during telehealth visits, including diplomas and credentials. This affects their perception of the doctor's expertise and trustworthiness, with lower composite scores for non-traditional environments like kitchens and bedrooms.
A new study finds mail-order pharmacy dispensing of mifepristone for medication abortion is effective, acceptable to patients, and feasible. This care model can improve access to medication abortion services and reduce the need for in-person screening.
A systematic review and meta-analysis found that low testosterone levels are associated with increased risk of all-cause mortality and cardiovascular death. Men with very low testosterone concentrations had a significantly higher risk of cardiovascular death, regardless of other hormone levels.
A study published in JAMA found that newly trained internal medicine physicians with top scores on the board certification exam had lower risk of dying within seven days or being readmitted to hospital. The analysis used nearly 7,000 patients and showed a significant link between exam scores and patient outcomes.
Text messaging and bulk ordering can significantly increase mammogram completion rates for breast cancer screening outreach. The study found that these interventions are effective in improving adherence to recommended screening guidelines.
A multisite review found that adverse events during outpatient care were relatively common and often serious, with 7% of outpatients experiencing at least one event. Adverse drug events were the most common, and these events occurred more frequently among older adults and were often preventable.
A previously healthy man developed toxic leukoencephalopathy after inhaling fentanyl, leading to inflammation in the brain and potentially irreversible damage. Fortunately, he slowly recovered with wraparound treatment from a multidisciplinary team at OHSU.
A study of 15 brand-name drugs found that competition from 'skinny label' generics saved Medicare nearly $15 billion from 2015 to 2021. The largest savings were seen for rosuvastatin, pregabalin, and imatinib, with actual spending being $16.8 billion versus projected spending of $31.5 billion.
An observational study of over 700,000 patients found that female physicians treated male and female patients with lower mortality and readmission rates. The effect was particularly pronounced in female patients treated by female physicians, possibly due to patient-centered communication and reduced sociocultural taboos.
Research suggests that female physicians have a clinically significant impact on patient outcomes, with lower mortality and readmission rates compared to male doctors. Female patients benefit more significantly from treatment by female physicians, possibly due to better communication and understanding of sensitive health issues.
A new study finds that initiating antihypertensive medication in older long-term care residents increases fracture risk, particularly among those with dementia. The study advises caution when prescribing antihypertensives to this vulnerable population.
The American College of Physicians recommends adding SGLT-2 and GLP-1 agonists to metformin in adults with Type 2 diabetes for improved cardiovascular outcomes. The guidelines prioritize shared decision-making, considering individual patient characteristics and values.
Only 4% of cancer survivors met all four American Cancer Society guidelines, with a mean of 2.0 guidelines met. This study aims to improve understanding of guideline adherence and inform recommendations for patients who have completed cancer treatments.
A new supplement published in Annals of Internal Medicine highlights important new evidence from 2023 that may have been missed by clinicians. The supplement features summaries of novel findings across eight medical disciplines, including cardiology, critical care, and oncology.
Over five RSV seasons, researchers found that nearly one-quarter of hospitalized adults aged 50+ experienced an acute cardiac event, mostly heart failure. The risk of severe outcomes was nearly twice as high in patients with cardiac events compared to those without.
A national cohort study of over 2 million Swedish women found that those experiencing five major adverse pregnancy outcomes had significantly higher mortality rates. The study highlights the importance of early preventive evaluation and long-term follow-up for detection and treatment of chronic disorders associated with premature morta...
A US study found that medical cannabis enrollment increased overall between 2016 and 2022, but decreased in states with legalized recreational use. The number of patients using cannabis for medical purposes has risen by over 600% since 2016.
A telephone-based strategy improved guideline-directed medical therapy rates for outpatients with heart failure by 30 days, offering a low-cost solution for rural settings with limited access to care. This study suggests the potential for expanded remote healthcare initiatives to address health disparities.
A new study suggests that most essential care for cardiovascular health happens in general primary care clinics, but many at high risk don't receive it. The study found that large percentages of people with major cardiovascular risk factors didn't see a primary care provider or cardiologist in the past year.
A study found that structural racism is largely to blame for disparities in tuberculosis (TB) incidence among the U.S.-born population. Researchers analyzed national TB registry data and found that TB incidence ratios were higher for certain racial and ethnic groups, with greater relative disparities among females.
A Mount Sinai study found that primary care physicians' approach to selecting patients with comorbidities for lung cancer screening is influenced by subjective clinical judgments. The researchers recommend streamlined protocols and clearer guidelines to increase adoption of lung cancer screening for this high-risk population.
Dr. Chana Sacks is the new Editor-in-Chief of NEJM Evidence, focusing on providing high-quality, practice-changing evidence for medical professionals. The journal aims to change how medical professionals think about generating evidence while making clinical learning engaging and fun.
A study found that an annual vaccination campaign with a second dose for children under 2 years old and individuals aged 50 and over can significantly reduce hospitalizations, deaths, and healthcare spending. The optimal timing for the second vaccination is delivering it 5 months after initial vaccination.
A study of 17,000 hospitalized adults found that inappropriate pneumonia diagnoses were common among older adults and those with dementia or altered mental status. Full-course antibiotic treatment for these patients may be detrimental to their health.
Researchers from Florida Atlantic University suggest that selecting an OTC medication for mild COVID-19 symptoms should be based on the entire benefit-to-risk profile of the patient. They caution against using traditional NSAIDs like ibuprofen and naproxen due to their similar but greater side effect profiles compared to aspirin.
A recent study found that digital reminders for flu vaccination increased vaccination rates among older adults in Denmark by one percentage point. However, it did not improve clinical outcomes, including hospitalization and death rates.
A 20-year analysis found that calcium and vitamin D supplements reduced cancer mortality by 7%, but increased cardiovascular disease mortality by 6% in postmenopausal women. The study suggested that cancer incidence depends on pre-supplementation status, while CVD mortality is higher among supplement users.
A large binational study found that SARS-CoV-2 infection was associated with an increased risk of autoimmune inflammatory rheumatic diseases (AIRDs) extending up to 12 months after infection. Vaccination showed some protection against AIRDs, particularly among those who were vaccinated.
A study by Dr. Yamamoto et al. discovered 200 types of proteins, including β2-m, adsorbed onto blood purification devices in dialysis patients. These proteins, such as lysozyme, are involved in amyloid fibril formation and may contribute to the disease progression.
A study of over 250 patients with Cushing's disease and nonfunctioning pituitary adenomas found that those who achieved remission were more likely to develop new-onset autoimmune disease within three years. Higher prevalence of adrenal insufficiency may have contributed to this development.
Prescription opioids linked to increased risk of serious falls among adults, with older individuals most vulnerable. Targeted prevention efforts may be most effective within the first month after opioid initiation.
Segregated neighborhoods contribute to racial disparities in live donor kidney transplantation. Targeted interventions, such as community outreach clinics, can help mitigate these effects and promote equitable access.
Hemodialysis patients experience itching due to high levels of protein-bound uremic toxins (PBUTs), which are difficult to remove by dialysis therapy. A new study found an association between PBUTs and itching, suggesting improved treatments for this common symptom.
A recent study reveals significant disparities in emergency department use among transgender and cisgender Medicare beneficiaries. The findings highlight increased utilization of emergent services, particularly for psychological care, which are more likely to lead to hospital admissions.
A study of emergency department visits reveals that most injuries from conducted energy devices, such as TASERs, involve young Black and white males from low-income areas. This finding is consistent with existing research on police violence and racial disparities in the US population.
A study of 18,000 women found those diagnosed with polycystic ovary syndrome (PCOS) were 8 times more likely to attempt suicide compared to control group. This increased risk is attributed to higher likelihood of psychiatric conditions such as depressive disorders and anxiety disorders associated with PCOS. Researchers emphasize the ne...
Officer-involved killings of unarmed Black individuals worsened sleep duration among Black respondents, while no adverse effects were found for white respondents. The study highlights the role of structural racism in shaping racial disparities in sleep health.
New research finds that Black, Indigenous, and People of Color (BIPOC) individuals experience greater negative impacts on their health status, activity levels, and ability to work after COVID-19 infection compared to white participants. The study highlights the need for equitable health interventions for underserved populations.
In a randomized clinical trial of 1,068 smokers, electronic cigarettes were shown to be as effective as varenicline in aiding smoking cessation, while being more effective than nicotine chewing gum. The study suggests that e-cigarettes may offer a viable alternative for quitting smoking with minimal behavioral support.
A study of 57,000 US adults found that lower levels of food security are associated with a higher risk of premature mortality and shorter life expectancy. The findings highlight the potential importance of improving food security in promoting population health and reducing health disparities.
A recent study of 35,000 adults aged 50+ found significant inequities in survival rates associated with wealth inequality in the US. Wealth redistribution policies have been proposed as a solution to reduce these disparities and increase population longevity.
A study of over 1.6 million ED visits found that nearly two-thirds of low-risk pulmonary embolism patients were hospitalized, despite evidence suggesting safety in outpatient management. Researchers suggest further investigation into ED triage decisions to improve appropriate use of outpatient care.
A recent study found that primary care physicians' electronic health record (EHR) workload has continued to grow, with PCPs spending nearly 30 minutes more on EHR tasks per clinic appointment between 2019 and 2023. This increased burden can lead to burnout and affect their ability to provide adequate care.
A cross-sectional study of over 6,500 adults aged 65+ found that older adults spent an average of 20.7 days per year receiving healthcare outside the home. The 'health care contact days' metric can help evaluate care and identify areas for improvement, such as coordinating tests with visits and reducing Friday office visits.
Researchers have developed a novel sequential ultrasound molecular imaging (USMI) approach to identify non-alcoholic steatohepatitis (NASH), offering a potential noninvasive diagnostic tool. The method uses microbubbles targeting CD36 and ICAM-1 to visualize hepatic steatosis and inflammation.
A clinical trial found that trazodone and cognitive behavioral therapy for insomnia were no more effective than placebo in improving insomnia symptoms among long-term dialysis patients. Serious adverse events also occurred more frequently with trazodone use. More trials are needed to investigate additional therapies for this condition.
A new poll found that only 7.5% of people between 50-80 have used at least one direct-to-consumer health care service, with most receiving prescriptions for a one-time treatment. Many users didn't inform their regular providers about the prescriptions.
Researchers found that specific microbes in the gut reduce graft versus host disease after stem cell transplantation. Patients with low microbial metabolite risk index had better survival rates, fewer graft vs. host reactions, and reduced relapses.
A study of over 5,000 adults found that acute hospital care at home (AHCaH) is associated with low mortality, escalation, and readmission rates among medically complex and socially vulnerable patients. AHCaH was also linked to improved experiences and physical activity levels.
Diagnostic errors in hospitalized adults who died or were transferred to the intensive care unit were common, with problems in test choice and clinician assessment identified as high-priority areas for improvement. The study analyzed 2,428 patient records at 29 hospitals and found that these errors led to significant patient harm.