American Journal of Medicine最新文献

{"title":"Ciliated muconodular papillary tumor: mimicking lung adenocarcinoma.","authors":"Anita Lascasas Trigueira, Luís Filipe Santos Silva, João Marques Macedo, Rita Matos Gomes, Susana Guimarães, Vanessa Santos, Jorge Ferreira","doi":"10.1016/j.amjmed.2025.03.028","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.03.028","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Validation of Risk Assessment Models for Venous Thromboembolism Risk in Hospitalized Medical Patients: Insights from a Multicenter Prospective Cohort Study.","authors":"Pedro Ruiz-Artacho, Mónica Olid Velilla, Fahd Beddar Chaib, Ramón Lecumberri, David Jiménez, Lourdes Hernández Castells, Héctor Alonso Valle, Jorge Pedraza García, Vanesa Sendín Martín, Línder Cárdenas Bravo, Alfonso Muriel, Sònia Jiménez Hernández","doi":"10.1016/j.amjmed.2025.03.027","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.03.027","url":null,"abstract":"<p><strong>Background: </strong>The optimal risk assessment model (RAM) for venous thromboembolism in hospitalized medical patients remains controversial. This study aimed to assess the prognostic performance of Padua, IMPROVE and NICE guidelines' RAMs.</p><p><strong>Methods: </strong>A multicenter prospective observational study was conducted in 15 Spanish hospitals, monitoring consecutive medical inpatients for symptomatic venous thromboembolism over a 90-day follow-up period. The discriminative performance was evaluated using time-to-event analyses and competing risk models accounting for non- venous thromboembolism-related mortality. Sensitivity, specificity, and area under the ROC curve (AUC) were calculated to assess predictive accuracy.</p><p><strong>Results: </strong>Among 1,273 patients, the 90-day cumulative venous thromboembolism incidence was 1.0%. After adjusting for pharmacological thromboprophylaxis, high-risk patients did not exhibit a significantly increased venous thromboembolism risk compared to low-risk patients according to Padua (aSHR 5.71; 95% CI 0.70-46.86), IMPROVE (aSHR 3.72; 95% CI 1.00-13.87), and NICE RAM (aSHR 0.97; 95% CI 0.30-3.18). Padua had the highest sensitivity (92.3% [95% CI, 62.1%-99.6%]) but lowest specificity (32.3% [95% CI, 29.7%-35.0%]), whereas IMPROVE exhibited the highest specificity (52.9% [95% CI, 50.1%-55.7%]) with moderate sensitivity (76.9% [95% CI, 46.0%-93.8%]). Discriminative performance was suboptimal for all RAMs (AUC: Padua 62.3%, IMPROVE 64.9%, NICE 50.1%).</p><p><strong>Conclusions: </strong>Padua, IMPROVE, and NICE RAMs demonstrated poor predictive accuracy in stratifying venous thromboembolism risk among hospitalized medical patients. These findings underscore the need for more precise, dynamic RAMs tailored to real-world clinical settings to enhance thromboprophylaxis and patient outcomes.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tackling Chronic Diseases from the Inside Out.","authors":"Elizabeth Siebeneck, Ralph Snyderman","doi":"10.1016/j.amjmed.2025.03.026","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.03.026","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Thyrotoxicosis-Induced Prinzmetal Angina Mimicking Acute ST-Elevation Myocardial Infarction.","authors":"Thomas M Ruli, David Szarvas, Alex D'Amico, Massoud Leesar","doi":"10.1016/j.amjmed.2025.03.018","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.03.018","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult intussusception with inverted Meckel's diverticulum as the leading point.","authors":"Akitomo Akao, Takuya Otsuki, Kosuke Ishizuka, Masafumi Katayama, Kenya Ie, Chiaki Okuse","doi":"10.1016/j.amjmed.2025.03.017","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.03.017","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maximizing the Value of Concierge Medicine: A Systematic Review of Cost, Access, and Outcomes.","authors":"Kelsey S Rylands, Campbell M Collins, Donald R Collins","doi":"10.1016/j.amjmed.2025.03.016","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.03.016","url":null,"abstract":"<p><p>Alternative models of care are emerging at an exponential rate. Concierge medicine is one such model touting personalized high-quality care and access to a robust panel of preventative health services. While limited evidence exists to confirm the benefits of concierge medicine on patient clinical outcomes, this model boasts significantly increased patient and physician satisfaction. Ethical concerns overshadow the future of concierge medicine; however, possibilities of improved clinical outcomes, decreased chronic disease progression, and timely illness management give this model merit. Maximizing the value of concierge medicine requires the strategic use of economic principles, such as a willingness to pay and an enticing customer value proposition. Further value can be found in the expansion of coverage eligibility and in the prudent delivery of personalized health services that reduce hospital admissions and national healthcare spending.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aspirin for Venous Thromboembolism Prophylaxis in Hip Fracture, Total Knee, and Hip Arthroplasty.","authors":"Hannah Leyva, John Fanikos, Zhou Lan, Giovanni Scimeca, Behnood Bikdeli, Gregory Piazza, Samuel Z Goldhaber","doi":"10.1016/j.amjmed.2025.03.020","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.03.020","url":null,"abstract":"<p><p>Venous thromboembolism is a complication of major orthopedic surgeries such as hip fracture repair, total knee arthroplasty, and total hip arthroplasty. Prophylaxis against venous thromboembolism reduces the risk of pulmonary embolism and deep vein thrombosis associated with these procedures. Aspirin is widely prescribed for venous thromboembolism prophylaxis in major orthopedic surgery. We review the epidemiology of hip fracture, total knee arthroplasty, and total hip arthroplasty, and describe aspirin's mechanisms of action, efficacy, and safety.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Signet ring cells in the skin.","authors":"David Bernal-Bello, Celia Lara-Montes, Mercedes Isabel Jaquero-Valero, Almudena Hernández-Núñez","doi":"10.1016/j.amjmed.2025.03.022","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.03.022","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Language and Readability Barriers in Discharge Instructions: A Call to Improve Patient Aftercare.","authors":"Maxwell Sahhar, Manjot Singh, Joseph E Nassar, Michael J Farias, Alex Hernandez-Manriquez, Bassel G Diebo, Alan H Daniels","doi":"10.1016/j.amjmed.2025.03.015","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.03.015","url":null,"abstract":"<p><strong>Background: </strong>Inadequate health literacy is linked to worse health outcomes, including higher readmission rates and adverse events. Despite recommendations to keep patient materials at or below a 6th-grade reading level, many discharge instructions exceed this threshold. This study examines the language availability of Epic's discharge documents and assesses alignment with readability standards.</p><p><strong>Methods: </strong>In December 2024, Epic discharge documents on adult medical conditions were extracted in English and Spanish, as well as their Easy-To-Read versions when available. Readability was assessed using two scoring systems for each language. Comparisons to the recommended grade levels and between document versions were analyzed using right-sided and paired t-tests, respectively. Trends in grade levels by the month of revision were assessed using linear regressions.</p><p><strong>Results: </strong>Across 1511 discharge instructions, the Standard documents were available in 15 languages. For Standard English documents, 81% surpassed the American Medical Association's 6th-grade threshold on FKGL (p<0.05) and 100% on SMOG (p<0.05). For Standard Spanish documents, 0% were above the threshold on Fernández-Huerta (p=1.00) and 100% on adjusted SMOG (p<0.05). The Easy-To-Read versions had significantly lower grade levels than their Standard counterparts (p<0.05). Regression analyses revealed no significant changes in the grade level of discharge documents by revision month (p>0.05).</p><p><strong>Conclusions: </strong>Epic's discharge instructions are infrequently offered in languages other than English and Spanish, and often exceed the recommended reading levels. Given the impact of readability on patient outcomes, discharge documents should be improved to enhance patient comprehension and adherence.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding Therapeutic Strategies for CAR-T cells.","authors":"Edward J Goetzl","doi":"10.1016/j.amjmed.2025.03.024","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.03.024","url":null,"abstract":"<p><p>A wide range of autologous and allogeneic immune cells bearing diverse chimeric antigen receptors (CARs) have been prepared to treat B cell and other hematological malignancies, some solid tumors, autoimmune diseases, graft vs. host disorders and transplantation rejection. Therapeutic CAR-immune cells bearing a specifically designed CAR, that binds a target cell antigen, home precisely to those target cells and signal alterations in their functions. The longest successful and now FDA-approved experience is with six systems of CAR-T cells recognizing malignant B cell surface antigens CD19 or B Cell Maturation Antigen (BCMA). CAR constructs in CAR-immune cell systems have been improved in multiple ways to increase persistence at lesions, minimize off-target effects and enhance cytotoxic or immunosuppressive effectiveness. Acute side-effects, such as adverse responses to CAR-immune cell-derived cytokines and neurological disorders, are common but have been reduced by elevated expression of cytokine receptors on CAR-immune cells. Allogeneic CAR-immune cells from normal donors may evoke graft vs. host reactions. Future improvements including mRNA editing of metabolic messages to minimize CAR-T cell exhaustion and viral approaches to creating autologous CAR-T cells in vivo will improve future therapeutic effectiveness and safety.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}