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CLOSING THE GAP BETWEEN MEDICAL KNOWLEDGE AND PATIENT OUTCOMES THROUGH NEW TRAINING INFRASTRUCTURE. 通过新的培训基础设施缩小医学知识与患者结果之间的差距。
Transactions of the American Clinical and Climatological Association Pub Date : 2023-01-01
Melvin Blanchard
{"title":"CLOSING THE GAP BETWEEN MEDICAL KNOWLEDGE AND PATIENT OUTCOMES THROUGH NEW TRAINING INFRASTRUCTURE.","authors":"Melvin Blanchard","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The biomedical research infrastructure of our academic medical centers elucidates disease mechanisms and develops diagnostic tests and treatments with scientific rigor, but the mechanism for reliably moving these findings into clinical settings lacks careful design. Hence, there is a wide gap between medical discoveries and the health benefit realized by the U.S. population. Performance improvement (PI) is a discipline that focuses on intentional redesign of core processes in our health system to close these gaps. The application of PI science is more consequential to health outcomes as is traditional biomedical research. This article describes why application and recognition of PI science as a discipline is imperative and why we should require training with similar intensity in undergraduate medical education (UME) and graduate medical education (GME). It also proposes investment in infrastructure (developing faculty expertise) and rigorous fellowships, which are, perhaps, more likely to thrive in teaching hospitals with a strong clinical mission.</p>","PeriodicalId":23186,"journal":{"name":"Transactions of the American Clinical and Climatological Association","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10493721/pdf/tacca1330000119.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41213842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
PRESIDENT'S ADDRESS: VIROLOGY THROUGH THE LENS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION. 总统致辞：从美国临床与气候协会的视角看病毒学。
Transactions of the American Clinical and Climatological Association Pub Date : 2023-01-01
Peter M Howley
{"title":"PRESIDENT'S ADDRESS: VIROLOGY THROUGH THE LENS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION.","authors":"Peter M Howley","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":23186,"journal":{"name":"Transactions of the American Clinical and Climatological Association","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10493715/pdf/tacca13300001.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41213857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
FGF23 AND ALTERED MINERAL HOMEOSTASIS IN KIDNEY DISEASE AND FOLLOWING INTRAVENOUS IRON. FGF23与肾脏疾病和静脉注射铁后矿物质稳态的改变。
Transactions of the American Clinical and Climatological Association Pub Date : 2023-01-01
Myles Wolf
{"title":"FGF23 AND ALTERED MINERAL HOMEOSTASIS IN KIDNEY DISEASE AND FOLLOWING INTRAVENOUS IRON.","authors":"Myles Wolf","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Fibroblast growth factor 23 (FGF23) is an endocrine hormone that stimulates renal phosphate excretion and suppresses circulating concentrations of 1,25-dihydroxyvitamin D (1,25D). These effects of FGF23 are most evident in rare diseases that are characterized by FGF23-mediated hypophosphatemic rickets-osteomalacia. More commonly, elevated FGF23 is a ubiquitous, early consequence of chronic kidney disease (CKD) in which it helps to maintain normal serum phosphate levels but causes secondary hyperparathyroidism by suppressing 1,25D, and directly promotes cardiovascular disease and death. Elevated FGF23 is also a common complication of intravenous administration of ferric carboxymaltose (FCM), which is widely used to treat iron deficiency anemia. Among patients with normal kidney function who receive FCM, the resulting increase in FGF23 and subsequent FGF23-mediated reduction of 1,25D and secondary hyperparathyroidism promote hypophosphatemia that can be symptomatic, severe, and associated with musculoskeletal complications. Ongoing research is needed to design novel therapeutic approaches to mitigate FGF23-related illnesses.</p>","PeriodicalId":23186,"journal":{"name":"Transactions of the American Clinical and Climatological Association","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10493719/pdf/tacca1330000262.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41213847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Former Officers 1884 Through 2022. 前军官1884年至2022年。
Transactions of the American Clinical and Climatological Association Pub Date : 2023-01-01
{"title":"Former Officers 1884 Through 2022.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":23186,"journal":{"name":"Transactions of the American Clinical and Climatological Association","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10493747/pdf/008-tacca1330000viii.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41213848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
GLUCOCORTICOIDS IN CHRONIC DISEASE: THE GOOD, THE BAD, THE BONE. 糖皮质激素在慢性病中的作用：好的，坏的，骨。
Transactions of the American Clinical and Climatological Association Pub Date : 2023-01-01
Kenneth G Saag
{"title":"GLUCOCORTICOIDS IN CHRONIC DISEASE: THE GOOD, THE BAD, THE BONE.","authors":"Kenneth G Saag","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Despite the advent of more targeted therapies, glucocorticoids (steroids) remain in chronic use (defined as > 3 months or more) by an estimated 0.5% of the population. Steroids yield symptomatic benefits for systemic and local inflammation as well as disease-modifying properties in rheumatoid arthritis, the most common disorder for their chronic use. Despite their many benefits, steroids have been associated with a myriad of common side effects. Observational studies of steroid safety are limited by confounding by indication, and randomized controlled trials have been too short and too small to understand their true safety profile. Glucocorticoid-induced osteoporosis (GIOP) occurs in a time- and dose-dependent way and is associated with both a reduction in bone formation and an increase in bone resorption. Numerous anti-osteoporotic therapies have efficacy for improving bone health among chronic glucocorticoid users, but implementation science approaches are needed to achieve adequate GIOP prevention and to reduce fracture outcomes.</p>","PeriodicalId":23186,"journal":{"name":"Transactions of the American Clinical and Climatological Association","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10493762/pdf/tacca133000069.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41213849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Present Members. 出席议员。
Transactions of the American Clinical and Climatological Association Pub Date : 2023-01-01
{"title":"Present Members.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":23186,"journal":{"name":"Transactions of the American Clinical and Climatological Association","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10493761/pdf/041-tacca1330000xli.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41213855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
THE BERT AND PEGGY DUPONT LECTURE: TUBERCULOSIS AND THE BUILDING OF THE AMERICAN WEST. 伯特和佩吉·杜邦的演讲：肺结核与美国西部的建设。
Transactions of the American Clinical and Climatological Association Pub Date : 2023-01-01
Eric J Rubin
{"title":"THE BERT AND PEGGY DUPONT LECTURE: TUBERCULOSIS AND THE BUILDING OF THE AMERICAN WEST.","authors":"Eric J Rubin","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":23186,"journal":{"name":"Transactions of the American Clinical and Climatological Association","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10493767/pdf/tacca1330000196.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41213908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Index. 索引。
Transactions of the American Clinical and Climatological Association Pub Date : 2023-01-01
{"title":"Index.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":23186,"journal":{"name":"Transactions of the American Clinical and Climatological Association","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10493729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
OFFICERS AND COUNCIL 2022. 官员和理事会2022。
Transactions of the American Clinical and Climatological Association Pub Date : 2023-01-01
{"title":"OFFICERS AND COUNCIL 2022.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":23186,"journal":{"name":"Transactions of the American Clinical and Climatological Association","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10493763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10230373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
DYSPNEA AND MECHANICAL VENTILATION: APPLYING PHYSIOLOGY TO GUIDE THERAPY. 呼吸困难与机械通气：应用生理学指导治疗。
Transactions of the American Clinical and Climatological Association Pub Date : 2023-01-01
Richard M Schwartzstein, Rachel Sturley
{"title":"DYSPNEA AND MECHANICAL VENTILATION: APPLYING PHYSIOLOGY TO GUIDE THERAPY.","authors":"Richard M Schwartzstein,&nbsp;Rachel Sturley","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>While advances in our understanding of mechanical ventilation have improved mortality from acute respiratory distress syndrome, recent studies indicate a rising incidence of post-ventilation mental health sequelae, including post-traumatic stress disorder (PTSD). Concurrent research on the physiology of dyspnea provides insights about the role of multiple sources of sensory information underlying respiratory discomfort along with the contribution of efferent-afferent dissociation to dyspnea, and the subsequent relationship of dyspnea to a range of affective responses, including fear and anxiety. An understanding of the mechanisms of dyspnea may provide holistic approaches to managing acute respiratory failure that can achieve the best physical and emotional outcomes for patients requiring mechanical ventilation.</p>","PeriodicalId":23186,"journal":{"name":"Transactions of the American Clinical and Climatological Association","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10493724/pdf/tacca1330000162.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41213844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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