American Journal of Medicine最新文献_第10页

Practical approaches to cardiac clearance in nontraditional clinical scenarios. 在非传统临床情况下心脏清除的实用方法。

IF 5.3 3区医学

American Journal of Medicine Pub Date : 2025-08-05 DOI: 10.1016/j.amjmed.2025.07.017

Ethan F Kramer, Jacob C Ricci, Krunal Shukla, Noah J Blaker, Sajan Shroff, Stephen J Brand, Tawfiq Khasawneh, Shruti Sreekanth, David E Winchester

{"title":"Practical approaches to cardiac clearance in nontraditional clinical scenarios.","authors":"Ethan F Kramer, Jacob C Ricci, Krunal Shukla, Noah J Blaker, Sajan Shroff, Stephen J Brand, Tawfiq Khasawneh, Shruti Sreekanth, David E Winchester","doi":"10.1016/j.amjmed.2025.07.017","DOIUrl":"10.1016/j.amjmed.2025.07.017","url":null,"abstract":"\"Cardiac clearance\" is frequently sought from clinicians before noncardiac procedures or activities that lack expert consensus guidelines regarding cardiovascular risk evaluation. In 2023, our research group published a review article in TheAmerican Journal of Medicine which summarized the evidence and recommendations for six \"nontraditional\" requests for cardiovascular risk evaluation. Since then, our group continued to receive similar requests. Here, we review the known literature and provide management recommendations for six more requests inspired by real referrals received by the authors. These requests highlight increasingly common therapies including hyperbaric oxygen therapy for wound healing, ketamine for treatment-resistant depression, antipsychotic therapy, and proton therapy to the chest. We also comment on the cardiovascular risk evaluation of being in a strenuous profession as a law enforcement officer and taking part in the less strenuous activity of bowling. Ultimately, we recommend taking a standardized, patient-centered approach to every cardiovascular risk evaluation, first learning about the procedure or activity, then understanding the pertinent physiology, and finally exploring the available literature regarding management.","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769257","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}

引用次数: 0

Population health approach to optimize SGLT-2 prescribing in a veteran cohort. 优化退伍军人SGLT-2处方的人群健康方法

IF 5.3 3区医学

American Journal of Medicine Pub Date : 2025-08-05 DOI: 10.1016/j.amjmed.2025.07.019

Jeffrey D Kravetz, Megan E Crete, Annette Pimenta, Alex S Quermorllue, Devin P Pray, Rebecca S Brienza

引用次数: 0

Clinical Use of Inpatient FDG-PET/CT in Internal Medicine. 住院患者fdg-pet / ct在内科的临床应用。

IF 5.3 3区医学

American Journal of Medicine Pub Date : 2025-07-30 DOI: 10.1016/j.amjmed.2025.07.028

Shoshana Amos, Matan Fischer, Fadi Kharouf, Limor Rubin, Simona Ben-Haim, Marina Orevi, Dror Mevorach

{"title":"Clinical Use of Inpatient FDG-PET/CT in Internal Medicine.","authors":"Shoshana Amos, Matan Fischer, Fadi Kharouf, Limor Rubin, Simona Ben-Haim, Marina Orevi, Dror Mevorach","doi":"10.1016/j.amjmed.2025.07.028","DOIUrl":"10.1016/j.amjmed.2025.07.028","url":null,"abstract":"Objective: FDG-PET/CT is useful in internal medicine for evaluation of patients with various inflammatory presentations. However, data regarding its diagnostic role in inpatients is limited. This study aims to assess the contribution of FDG-PET/CT in hospitalized patients.Methods: An observational cohort study was conducted at a tertiary medical center in Israel from 2015 to 2020. We analyzed FDG-PET/CT scans of 260 adult inpatients from Internal Medicine, Cardiology, Medical Intensive Care, and Intensive Cardiac Care units. Scans done solely for malignancy follow-up were excluded. The primary outcome was a change in diagnosis and/or management, assessed by at least two physicians.Results: Among the 260 patients, indications included infection (42%), inflammation (35%), suspected malignancy (17%), cardiac disease (5%), and other (1%). 80% of studies were clinically helpful. In 40% treatment was changed, either in type (27%) or duration (13%). 9% of studies contributed to diagnosis alone, and 7% contributed to localization. 23% were negative studies, eliminating additional testing. 1% showed incidental findings requiring treatment. In 43% of studies, there were new findings that were not visible by prior morphologic imaging. A significantly higher percentage of clinically helpful studies was observed in patients with foreign devices compared with those without devices (89% versus 74%, P = 0.003), while immunocompromised patients had a lower percentage of clinically helpful studies (74% versus 84%, P = 0.06).Conclusion: FDG-PET/CT is a useful, noninvasive diagnostic tool in patients hospitalized in Internal Medicine, Cardiology, and Intensive Care. This modality may aid in treatment and prevent unnecessary invasive procedures in selected patients.","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765771","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}

引用次数: 0

Brand-Names and Higher-Cost Generics Drive Avoidable Medicare Part D Expenditures: A Quantitative Analysis Using ACEis and ARBs as a Model. 品牌和高成本仿制药驱动可避免的医疗保险D部分支出：以ACEis和arb为模型的定量分析。

IF 5.3 3区医学

American Journal of Medicine Pub Date : 2025-07-30 DOI: 10.1016/j.amjmed.2025.07.020

Ji Mei May Wong, James A Reiffel, Peter R Kowey

{"title":"Brand-Names and Higher-Cost Generics Drive Avoidable Medicare Part D Expenditures: A Quantitative Analysis Using ACEis and ARBs as a Model.","authors":"Ji Mei May Wong, James A Reiffel, Peter R Kowey","doi":"10.1016/j.amjmed.2025.07.020","DOIUrl":"10.1016/j.amjmed.2025.07.020","url":null,"abstract":"Objectives: Serving more than 50 million beneficiaries, Medicare Part D has a responsibility to balance broad prescription drug coverage with fiscal sustainability. We provide an up-to-date assessment of expenditures and cost-saving opportunities within the program, exemplified by our analysis on angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs). Our objectives were to characterize trends in utilization and spending on ACEis and ARBs among Part D beneficiaries, and to model potential savings from substituting (a) every brand-name prescription with therapeutically equivalent generics, or (b) every prescription with the least expensive generic in each drug class.Methods: This was a retrospective analysis of the latest Medicare Part D database, containing prescription drug expenditure data from 2018 to 2022.Results: Between 2018 and 2022, the number of Part D enrollees increased from 44,249,461 to 50,305,097 (+13.7%). The number prescribed an ACEi or ARB rose from 18,625,796 to 20,643,466 (+10.8%), while annual expenditures on these drugs grew from $1.25 billion to $1.28 billion (+2.30%). Cost per dosage unit of brand-names remained largely unchanged (ACEis: -1.36%; ARBs: -1.98%), while generics saw a more notable price reduction (ACEis: -26.4%; ARBs: -13.3%). Over the years studied, we estimated potential cumulative savings of 1) $429 million with complete generic substitution, and 2) $2.66 billion by defaulting all prescriptions to the lowest-cost generic within each drug class.Conclusion: Substantial savings are possible with both 1) complete generic substitution, and 2) mandatory use of the least costly generic formulation. Comparable opportunities likely exist for other widely prescribed drugs.","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762223","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}

引用次数: 0

Graves' disease and hypokalemic periodic paralysis: A case series. 格雷夫斯病和低钾性周期性麻痹：一个病例系列。

IF 5.3 3区医学

American Journal of Medicine Pub Date : 2025-07-30 DOI: 10.1016/j.amjmed.2025.07.031

Joseph Arguinchona, Nick Allen, Aditi Kumar, Krupa Doshi

引用次数: 0

Fire-eater's pneumonia: exogenous lipoid pneumonia in a young circus performer. 吞火者肺炎：一位年轻马戏团演员的外源性脂质肺炎。

IF 5.3 3区医学

American Journal of Medicine Pub Date : 2025-07-29 DOI: 10.1016/j.amjmed.2025.07.029

Anita Lascasas Trigueira, João Marques Macedo, Luís Filipe Santos Silva, Alcinda Reis, Oksana Sokhatska, Marília Beltrão, Margarida Costa E Silva, Rita Matos Gomes, Jorge Ferreira

引用次数: 0

Recurrent swelling in the floor of the mouth. 口腔底部反复肿胀。

IF 5.3 3区医学

American Journal of Medicine Pub Date : 2025-07-29 DOI: 10.1016/j.amjmed.2025.07.033

Takuma Watanabe, Makoto Hirota

引用次数: 0

Whatever happened to 'our national obsession with potassium?' 不是说“我们国家对钾的痴迷”吗？

IF 5.3 3区医学

American Journal of Medicine Pub Date : 2025-07-29 DOI: 10.1016/j.amjmed.2025.07.034

Franz H Messerli, Rajiv Agarwal, Emrush Rexhaj

引用次数: 0

An enigmatic post-travel presentation of nephrotic syndrome. 旅行后肾病综合征的神秘表现。

IF 5.3 3区医学

American Journal of Medicine Pub Date : 2025-07-29 DOI: 10.1016/j.amjmed.2025.07.022

Anna Lichtiger, Mollie Gellman, James Pullman, Scott Schafler

引用次数: 0

Herpes zoster presenting as a penile rash: Pearls and pitfalls. 带状疱疹表现为阴茎皮疹：珍珠和陷阱。

IF 5.3 3区医学

American Journal of Medicine Pub Date : 2025-07-29 DOI: 10.1016/j.amjmed.2025.07.016

Bibek Koirala, Jennifer P Wang

引用次数: 0