Internal Medicine最新文献_第3页

Effects of Protocol-driven Care by Internists on Adherence to Clinical Practice Guidelines for Hip Fracture Surgery Patients: An Interrupted Time Series Study Using a Nationwide Inpatient Database. 内科医生方案驱动护理对髋部骨折手术患者遵守临床实践指南的影响：一项使用全国住院患者数据库的中断时间序列研究。

IF 1 4区医学

Internal Medicine Pub Date : 2025-07-15 Epub Date: 2025-01-03 DOI: 10.2169/internalmedicine.4358-24

Ayako Tsunemitsu, Jung-Ho Shin, Osamu Hamada, Takahiko Tsutsumi, Noriko Sasaki, Susumu Kunisawa, Yuichi Imanaka

{"title":"Effects of Protocol-driven Care by Internists on Adherence to Clinical Practice Guidelines for Hip Fracture Surgery Patients: An Interrupted Time Series Study Using a Nationwide Inpatient Database.","authors":"Ayako Tsunemitsu, Jung-Ho Shin, Osamu Hamada, Takahiko Tsutsumi, Noriko Sasaki, Susumu Kunisawa, Yuichi Imanaka","doi":"10.2169/internalmedicine.4358-24","DOIUrl":"10.2169/internalmedicine.4358-24","url":null,"abstract":"Objective Patients with hip fractures tend to have a poor prognosis. Although guideline-compliant practices are known to improve patient outcomes, there is a lack of evidence regarding the use of intervention to improve guideline adherence in hip fracture patients. The objective of our study was to evaluate guideline adherence by internists providing care to patients with hip fractures, using a protocol developed based on various guidelines. Method Protocol-driven care for hip fracture patients by internists began in April 2018 at our hospital. After its initiation, orthopedic surgeons performed the surgery, and the internists provided all other medical care. A controlled interrupted time-series analysis was used to evaluate the effects of protocol-driven care on guideline adherence to compare our hospital with other hospitals, using data extracted from a nationwide Japanese inpatient database covering the period April 2014 to March 2023. Results A total of 221,620 inpatients from 373 hospitals were included in the study. The initiation of protocol-driven care was associated with the guideline-recommended prescriptions: osteoporosis medication (incidence rate ratio (IRR): 8.09; 95% confidence interval (CI) 4.02-17.7), acetaminophen (IRR: 2.11; 95% CI 1.55-2.90), non-steroidal anti-inflammatory drugs (IRR: 0.16; 95% CI 0.11-0.24), and opioids (IRR: 5.96; 95% CI 3.14-12.2). However, there was no effect on the proportion of benzodiazepine prescriptions, surgery within 48 hours, deep venous thrombosis prophylaxis, or other perioperative outcomes, including medical fees. Conclusion The initiation of protocol-driven care by internists resulted in improved adherence to osteoporosis medication prescriptions and postoperative analgesic use compared with orthopedic care. This approach can be used as an effective method of care for elderly patients undergoing surgery.","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2124-2135"},"PeriodicalIF":1.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Delayed Improvement of Magnetic Resonance Imaging Findings in Hashimoto's Encephalopathy. 桥本脑病磁共振成像表现的延迟改善。

IF 1 4区医学

Internal Medicine Pub Date : 2025-07-15 Epub Date: 2024-12-26 DOI: 10.2169/internalmedicine.4704-24

Toshihiro Ide, Yukako Inoue, Kohei Suzuyama, Haruki Koike

引用次数: 0

Aortic Intimal Sarcoma Diagnosed by Surgical Resection. 经手术切除诊断的主动脉内膜肉瘤1例。

IF 1 4区医学

Internal Medicine Pub Date : 2025-07-15 Epub Date: 2025-01-15 DOI: 10.2169/internalmedicine.4651-24

Yuki Horiguchi, Kazuya Nishii, Keisuke Shiraha, Taisaku Koyanagi, Takahiro Umeno, Tomoki Tamura, Shoichi Kuyama

引用次数: 0

Authors' Response to "If Status Epilepticus Disappears with Tocilizumab, Paucisymptomatic SARS-CoV-2 Infection Should Be Suspected". 作者对“如果Tocilizumab使癫痫持续状态消失，则应怀疑无症状的SARS-CoV-2感染”的回应。

IF 1 4区医学

Internal Medicine Pub Date : 2025-07-15 Epub Date: 2025-04-19 DOI: 10.2169/internalmedicine.5371-25

Yumiko Nakamura, Masayuki Ueda, Satoshi Kodama, Tomohiko Kimura, Yuichiro Shirota, Masashi Hamada, Hiroyuki Ishiura, Takahiro Iizuka, Tatsushi Toda

引用次数: 0

Fatal C-reactive Protein-less Sepsis with Anti-IL-6 Autoantibody Production after Administration of Durvalumab. 服用Durvalumab后产生抗il -6自身抗体的致死性c反应蛋白缺失脓毒症。

IF 1 4区医学

Internal Medicine Pub Date : 2025-07-15 Epub Date: 2024-12-19 DOI: 10.2169/internalmedicine.4754-24

Shunya Igarashi, Takunori Ogawa, Toshihiro Kushibiki, Koki Ito, Akira Matsukida, Yoshiki Kato, Kaori Nagao, Akihiko Kawana, Yoshifumi Kimizuka

引用次数: 0

Japanese Spotted Fever with Severe Myositis: A Diagnostic Challenge. 日本斑疹热伴严重肌炎：诊断挑战。

IF 1 4区医学

Internal Medicine Pub Date : 2025-07-15 Epub Date: 2024-12-26 DOI: 10.2169/internalmedicine.4813-24

Keigo Kobayashi, Haruna Baba, Riki Takeda, Susumu Nishiyama, Shu Nakamoto, Yasuhiro Umekawa

引用次数: 0

White Blood Cell Count and Lymphocyte-to-monocyte Ratio as a Screening Tool for Predicting Intravascular Lymphoma in the Differential Diagnosis of Fever of Unknown Origin. 白细胞计数和淋巴细胞/单核细胞比值作为预测血管内淋巴瘤在不明原因发热鉴别诊断中的筛选工具。

IF 1 4区医学

Internal Medicine Pub Date : 2025-07-15 Epub Date: 2024-12-26 DOI: 10.2169/internalmedicine.4682-24

Naoto Minematsu, Nanase Honda, Naoto Yokogawa

{"title":"White Blood Cell Count and Lymphocyte-to-monocyte Ratio as a Screening Tool for Predicting Intravascular Lymphoma in the Differential Diagnosis of Fever of Unknown Origin.","authors":"Naoto Minematsu, Nanase Honda, Naoto Yokogawa","doi":"10.2169/internalmedicine.4682-24","DOIUrl":"10.2169/internalmedicine.4682-24","url":null,"abstract":"Objective Intravascular large B-cell lymphoma (IVLBCL) is a critical cause of fever of unknown origin (FUO). While a pathological analysis is essential for diagnosing IVLBCL, the indications for an invasive procedure may be ascertained using easy, non-invasive tests. The lymphocyte-to-monocyte ratio (LMR) can reportedly predict the diagnosis of malignant lymphoma in patients with lymphadenopathy; however, its clinical utility in predicting an IVLBCL diagnosis in patients with FUO remains to be elucidated. Methods The medical records of 91 patients with FUO who underwent a skin biopsy for suspected IVLBCL between January 2010 and April 2023 were retrospectively reviewed. Patients Seventeen and 60 patients with and without pathologically diagnosed IVLBCL, respectively, were included in the analysis. The laboratory data nearest to the timing of the skin biopsy were then compared between the groups. Results Among the variables with an intragroup difference, a low white blood cell (WBC) count and LMR were predictors of an IVLBCL diagnosis after adjusting for covariates. A receiver operating characteristic analysis demonstrated that a WBC ≤7,200 and LMR ≤3.0 predicted the diagnosis with a sensitivity of 88.2% and 100%, and a specificity of 65.0% and 43.3%, respectively. In addition, the probability of IVLBCL increased to 71.4% in patients with both variables but was 0% in those with neither variable, indicating its potential utility in determining the need for an invasive procedure. Conclusion The WBC count and LMR predicted an IVLBCL diagnosis in patients presenting with FUO.","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2108-2113"},"PeriodicalIF":1.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hepatocellular Carcinoma Complicated by Fulminant Type 1 Diabetes Mellitus Shortly After Initiation of Durvalumab Plus Tremelimumab. Durvalumab联合Tremelimumab治疗后不久肝细胞癌并发暴发性1型糖尿病1例

IF 1 4区医学

Internal Medicine Pub Date : 2025-07-15 Epub Date: 2024-12-26 DOI: 10.2169/internalmedicine.4688-24

Nanase Usui, Yukinori Imai, Kayoko Sugawara, Yoshihito Uchida, Nobuaki Nakayama, Tomoaki Tomiya, Suguru Mizuno, Satoshi Mochida

引用次数: 0

Metachronous Pancreatic Cancer with Pancreaticobiliary Maljunction Diagnosed Five Years after Cholecystectomy for Gallbladder Cancer, in Which Follow-up Imaging Was Possible Until the Onset of Cancer: A Case Report and Review of the Literature. 胆囊癌胆囊切除术后5年诊断为异时性胰胆管畸形的胰腺癌，可随访影像学直到癌症发病：1例报告和文献回顾。

IF 1 4区医学

Internal Medicine Pub Date : 2025-07-15 Epub Date: 2025-01-15 DOI: 10.2169/internalmedicine.4581-24

Masaki Miyazawa, Masahiro Yanagi, Tomoyoshi Chiba, Kazuki Nagai, Hidenori Kido, Saiho Sugimoto, Masaki Nishitani, Noriaki Orita, Noboru Takata, Tomoyuki Hayashi, Akihiro Seki, Hidetoshi Nakagawa, Kouki Nio, Takeshi Terashima, Noriho Iida, Shinya Yamada, Hajime Takatori, Tetsuro Shimakami, Eishiro Mizukoshi, Masao Honda, Taro Yamashita

{"title":"Metachronous Pancreatic Cancer with Pancreaticobiliary Maljunction Diagnosed Five Years after Cholecystectomy for Gallbladder Cancer, in Which Follow-up Imaging Was Possible Until the Onset of Cancer: A Case Report and Review of the Literature.","authors":"Masaki Miyazawa, Masahiro Yanagi, Tomoyoshi Chiba, Kazuki Nagai, Hidenori Kido, Saiho Sugimoto, Masaki Nishitani, Noriaki Orita, Noboru Takata, Tomoyuki Hayashi, Akihiro Seki, Hidetoshi Nakagawa, Kouki Nio, Takeshi Terashima, Noriho Iida, Shinya Yamada, Hajime Takatori, Tetsuro Shimakami, Eishiro Mizukoshi, Masao Honda, Taro Yamashita","doi":"10.2169/internalmedicine.4581-24","DOIUrl":"10.2169/internalmedicine.4581-24","url":null,"abstract":"Whether or not pancreaticobiliary maljunction (PBM) is a risk factor for pancreatic cancer (PC) is unclear. We present a case of metachronous PC with PBM diagnosed after cholecystectomy for gallbladder cancer, in which follow-up imaging was possible until PC onset. A 63-year-old man who had been diagnosed with gallbladder cancer and had undergone cholecystectomy 5 years earlier developed pancreatitis. Pancreatography revealed PBM, and pancreatic duct brush cytology revealed adenocarcinoma. On reviewing the follow-up images, pancreatic morphological abnormalities, which had not been observed before cholecystectomy, were found to have gradually progressed, suggesting that biliopancreatic reflux led to pancreatic carcinogenesis.","PeriodicalId":13719,"journal":{"name":"Internal Medicine","volume":" ","pages":"2170-2177"},"PeriodicalIF":1.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

High Altitude Pulmonary Edema Associated with Climbing Mount Fuji. 攀登富士山引起的高原肺水肿1例。

IF 1 4区医学

Internal Medicine Pub Date : 2025-07-15 Epub Date: 2025-01-03 DOI: 10.2169/internalmedicine.4590-24

Yosuke Fukuda, Naruhito Oda, Kensuke Izumizaki, Akihiko Tanaka, Hironori Sagara

引用次数: 0