American Journal of Medicine最新文献

{"title":"Patient Simulation-Based Primary Care Training to Increase Evidence-Based COPD Care and Value-Based Success: Real-World Cost and Quality Impact Analysis.","authors":"Bruce Muma, Courtland Keteyian, David Kolde, Sean Drake, Diane George, Michael Foust, Steven Fried, Jodie Elsberg, Sharon Thomas, Lily Johnston, Alan Kulawczyk, David Paculdo, Isabella Cooney, John Peabody, Trever Burgon","doi":"10.1016/j.amjmed.2025.05.032","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.05.032","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188455","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":"Higher Risk of Kidney Failure Associated with Angiotensin Receptor Blockers Versus ACE Inhibitors in Patients with Heart Failure.","authors":"Hans J Moore, Wen-Chih Wu, Paul A Heidenreich, Patrick Rossignol, Samir S Patel, Frederick Lu, Phillip H Lam, Amiya A Ahmed, Charles Faselis, Javed Butler, Carlos E Palant, Bertram Pitt, Matthew R Weir, Prakash Deedwania, David Atkins, Venkatesh K Raman, Janani Rangaswami, Jose D Vargas, Sijian Zhang, Charity J Morgan, Helen M Sheriff, Qing Zeng-Treitler, Gregg C Fonarow, Ali Ahmed","doi":"10.1016/j.amjmed.2025.05.024","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.05.024","url":null,"abstract":"<p><strong>Background: </strong>Renin-angiotensin system (RAS) inhibition with angiotensin-covering enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is associated with a lower risk of kidney failure in patients with heart failure. We examined whether this association varies between ACEIs and ARBs.</p><p><strong>Methods: </strong>From 300,361 Veterans with heart failure without kidney failure initiated on ACEIs (n=256,224) or ARBs (n=44,137), we assembled a propensity score-matched cohort of 88,178 patients while remaining blinded to study outcomes. Hazard ratio (95% CI) for 5-year kidney failure in patients in the ARB group was estimated. Kidney failure was defined as receipt of kidney replacement therapy or persistent drop in baseline estimated glomerular filtration rate (eGFR) to <15 mL/min/1.73m².</p><p><strong>Results: </strong>Matched patients had mean age 71 years, ejection fraction 44%, eGFR 70 mL/min/1.73m², 97% were male, 18% African American, 23% received ACEIs or ARBs in high doses, and were balanced on 76 baseline characteristics. Kidney failure occurred in 4.4% (1961/44,089) and 5.4% (2389/44,089) of the patients in the ACEI and ARB groups, respectively. When accounted for the competing risk of death, patients in the ARB group had a 20% (95% CI, 13-28%) higher risk of kidney failure, which was similar in low-dose and high-dose subgroups. The associated risk of death was 5% (95% CI, 3-7%) lower in the ARB group, which was only significant in the low-dose group (7% vs 0%; interaction p, 0.007).</p><p><strong>Conclusion: </strong>In patients with heart failure, ARBs (vs. ACEIs) are associated with a higher risk of incident kidney failure. These findings need to be confirmed in future clinical trials.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152826","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":"Leveraging Medical Licensure for Safer Artificial Intelligence Use in Health Care.","authors":"D Douglas Miller, M Vinayak Kamath, John Albers, David C Hess","doi":"10.1016/j.amjmed.2025.05.012","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.05.012","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152827","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":"Assessing the Efficacy of Direct Oral Anticoagulants in Nonbacterial Thrombotic Endocarditis Patients.","authors":"Danny Tran, Si Young An, Shayna Hale, Faseeh Khaja","doi":"10.1016/j.amjmed.2025.05.025","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.05.025","url":null,"abstract":"<p><strong>Background: </strong>Nonbacterial thrombotic endocarditis is a rare condition associated with hypercoagulable states, including malignancy and autoimmune disorders. While unfractionated heparin and low molecular weight heparin (LMWH) are recommended first-line anticoagulants, evidence on the use of warfarin and direct oral anticoagulants (DOACs) remains limited.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed hospitalized patients with nonbacterial thrombotic endocarditis from January 1, 2016, to December 31, 2022, using the HCA Healthcare enterprise database. Patients receiving anticoagulation with unfractionated heparin, LMWH, warfarin, or DOACs were included. After excluding 759 patients for missing data, multiple anticoagulants, or extreme length of stay, 3,130 patients remained for analysis. Primary outcomes were thromboembolic events, mortality, hospital length of stay, and intensive care unit length of stay.</p><p><strong>Results: </strong>No statistically significant difference in thromboembolic events (p = 0.599) or mortality (p = 0.092) was observed among anticoagulant classes. Cardiac comorbidities were associated with decreased thromboembolic risk (OR = 0.3879), while age, malignancy, chronic kidney disease, and cardiac history were associated with higher mortality. Mean hospital length of stay was significantly longer in patients receiving heparin or LMWH (5.94 days) compared to those on DOACs (4.41 days) or warfarin (4.54 days; p < 0.05). Intensive care unit length of stay did not differ by anticoagulant class.</p><p><strong>Conclusion: </strong>Warfarin and DOACs may be viable alternatives to heparin-based therapy in nonbacterial thrombotic endocarditis, with comparable thromboembolic and mortality outcomes. However, heparin-based regimens were associated with longer hospital stays. Further prospective studies are warranted to guide anticoagulation strategies in nonbacterial thrombotic endocarditis.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144248","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":"Improving the OTC Drug Approval Process: A Public Health Priority.","authors":"Andrea Leonard-Segal, Bernard G Simone","doi":"10.1016/j.amjmed.2025.05.020","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.05.020","url":null,"abstract":"<p><p>There was no financial or non-financial assistance provided by a third party for the reported work. The article was written independently of any naloxone manufacturer. Both authors worked on the development of naloxone for OTC approval on behalf of a nonprofit 501(c)(3) company, Dr. Andrea Leonard-Segal as a consultant and Mr. Bernard Simone as Chief Operating Officer. Neither has had any relationship with the company since naloxone was approved by the FDA almost two years ago. Dr. Leonard-Segal's consulting agreement ended in the summer of 2023 and Mr. Simone retired from the company in the summer of 2023. Both authors had access to the data and participated in writing the manuscript. Neither author holds patents or copyrights relevant to the work in the manuscript.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144209","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":"The combination of afternoon and midnight salivary cortisol improves the diagnosis of Cushing's syndrome.","authors":"Luana Lionetto, Donatella De Bernardini, Giuseppe Costanzi, Roberta Maggio, Maria Elena Aloini, Guido Roberto, Francesca Ricci, Irene Biondo, Pina Lardo, Gerardo Salerno, Maurizio Simmaco, Antonio Stigliano","doi":"10.1016/j.amjmed.2025.04.035","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.04.035","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of Cushing's syndrome is challenging and often fraught with many pitfalls depending on several factors. We compare the diagnostic performance of AM serum cortisol (SC), 24-hour urinary free cortisol (UFC) and 0800 h, 1400 h and 2400 h salivary cortisol curve (SCC) in dexamethasone suppression test 1mg (1mg-DST) positive and negative patients.</p><p><strong>Methods: </strong>83 subjects performed measurements of SCC by Liquid Chromatography tandem Mass Spectrometry (LC-MS/MS) method, exploiting the circadian rhythm of cortisol.</p><p><strong>Results: </strong>The reproducibility and specificity of the test identify patients with hypercortisolism in 95% of cases at midnight. Interestingly, when considering two specific points (1400 h and 2400 h) on the SCC, the success rate rises to 100%.</p><p><strong>Conclusion: </strong>The evaluation of the 1400 h and 2400 h assays lead to detection of the total number of patients with Cushing's syndrome. SCC is a non-invasive diagnostic strategy associated with elevated positive predictive value for hypercortisolism capable of enabling diagnosis. In addition, it can be considered for management of patient outcomes and monitoring of Cushing's syndrome pharmacological treatment.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144215","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":"Large Language Models are Not Role Models: A Meditation on Master Clinicians.","authors":"Jason E Liebowitz, Marcy B Bolster, Philip Seo, Rita Charon","doi":"10.1016/j.amjmed.2025.05.028","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.05.028","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144212","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":"An Unexpected Case of Hyperammonemia in Cirrhosis.","authors":"James Yang, Rohit Agrawal, Adam Mikolajzcyk","doi":"10.1016/j.amjmed.2025.05.027","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.05.027","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144244","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":"Obstructive Hydrocephalus in Metastatic Urothelial Carcinoma.","authors":"Ami Schattner, Livnat Uliel, Ina Dubin","doi":"10.1016/j.amjmed.2025.05.015","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.05.015","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132753","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":"Undifferentiated Myopathies.","authors":"Katie Collins, Andrew Hoellein","doi":"10.1016/j.amjmed.2025.05.026","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.05.026","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132867","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}