Articles tagged with Internal Medicine
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.
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.
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.
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.
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 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.
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.
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 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.
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.
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.
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.
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 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.
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.
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.
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.
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 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.
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.
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.
The American College of Physicians (ACP) recommends removing barriers to participating in the electoral process to advance health equity. ACP supports policies ensuring safe and equitable access to voting, opposes partisan gerrymandering, and encourages civic participation among healthcare professionals.
A systematic review and meta-analysis of 15 clinical trials found daily tooth brushing may reduce hospital-acquired pneumonia rates by up to 50% in high-risk patients. This study suggests that widespread toothbrushing policies could save lives and reduce healthcare costs.
A recent study published in Gastroenterology & Endoscopy found that narrow-band imaging at low magnification can detect lesions missed by white-light imaging. Annual endoscopic examinations using LM-NBI revealed a threefold higher detection rate of neoplastic lesions compared to conventional magnifying endoscopy.
A Northwestern University study found that nearly two-thirds of patients discontinue or change their medication within a year, highlighting the need for better understanding of barriers to treatment adherence. The high discontinuation rate for GLP-1 RAs may be due to gastrointestinal side effects.
Research reveals SARS-CoV-2 RNA presence in extracellular vesicles of patients with negative PCR tests, suggesting a potential source for recurrent infections. The discovery may aid in identifying individuals with persistent or recurrent COVID-19 infections and offer new avenues for therapeutic interventions.
According to a new study published in Annals of Internal Medicine, most adults who qualify for statin use for primary prevention are not receiving them. The study found that despite increased overall statin use over time, only 35% of eligible adults were taking statins between 2013 and 2018. The researchers suggest that innovative effo...
Researchers at Osaka Metropolitan University have successfully developed a novel pneumococcal vaccine that demonstrates efficacy in suppressing pneumococcal pneumonia in macaques. The vaccine's design combines proprietary mucosal vaccine technology with pneumococcal surface proteins to cover a wide range of serotypes.
A randomized trial found that unfiltered traffic-related air pollution caused a rapid and significant increase in blood pressure, which persisted for more than 24 hours. The study suggests that effective cabin air filtration may reduce the negative effects of air pollution on blood pressure.
A study of 438,000 U.S. adults found that smoking cessation can significantly reduce cardiovascular, cancer, and respiratory mortality rates. Within a decade of quitting, former smokers' risk of cardiovascular death was approximately one-third that of continuing smokers.
A study of over 2.9 million patients found that gender concordance was associated with lower mortality for female patients, but higher mortality for male patients. The quality of surgical care provided by female surgeons is equivalent to or slightly better than that provided by male surgeons.
Researchers found that acupuncture improved symptoms in patients with chronic spontaneous urticaria (CSU), but the benefits were not significant enough to meet the minimal clinical difference threshold. The study included over 300 participants and suggested that clinicians should consider using acupuncture as an adjunctive treatment.
The COVID-19 pandemic and drug overdose epidemic significantly contributed to the widening gender gap in US life expectancy. Chronic metabolic disease and mental illness are also thought to play a role in the growing disparity.
A study found that 20% of patients treated with nirmatrelvir-ritavir (N-R) experienced virologic rebound, a phenomenon where viral load increases after initial decline. In contrast, only 1 untreated patient was affected. The researchers suggest considering the risks and benefits of N-R treatment in patients at low risk for severe disease.
A nationally representative survey reveals a shift in tobacco use among young adults, with historically low cigarette use and higher e-cigarette use. Exclusive e-cigarette users are unlikely to transition to combustible tobacco.
A study found that physicians who presented treatments for obesity as good news and an opportunity were more successful in helping patients lose weight. Patients who received counseling with a positive and optimistic tone had significantly higher weight loss outcomes compared to those who received neutral or negative advice.
A novel multicomponent intervention aimed at improving patient access to kidney transplants did not significantly increase the rate of completed steps in a randomized clinical trial involving 20,375 patients. The study highlights the need for sustained efforts to address barriers to transplantation globally.
Research at Niigata University demonstrated the GH-IGF-1 axis's role in inhibiting fatty liver disease progression. The study highlights the significance of brain peptide dynamics in maintaining pathological homeostasis, suggesting therapeutic potential for IGF-1 release.