American Journal of Medicine最新文献

{"title":"Forging the \"Bamboo Ceiling\": A Narrative Review on the Impact to the Advancement of Asians, Asian Americans and Pacific Islanders in Medicine.","authors":"Olivia Gong, Vinay Kumar, Anson O'Young, So Hyun Jeon, Ho-Man Yeung","doi":"10.1016/j.amjmed.2025.06.037","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.037","url":null,"abstract":"<p><p>The \"bamboo ceiling\" encompasses the systemic barriers that limit upward mobility of Asians and Pacific Islanders (APIs) in the professional setting. While having a broad reaching effect on many people in academic medicine, the bamboo ceiling is often considered to be of lower priority in the context of diversity and can be overlooked. In this review, we investigate the existing information on the bamboo ceiling, focusing on its origins, misconceptions, and manifestations especially as they pertain to the field of medicine. Disaggregating data on API populations would allow for greater understanding of the effects of the bamboo ceiling.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530918","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":"Trust is Earned.","authors":"Gina Piscitello, William E Rosa, Robert Arnold","doi":"10.1016/j.amjmed.2025.06.026","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.026","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530926","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":"Medical Hyperbole: An Unnecessary Element in Scientific Clinical Presentations.","authors":"Joseph S Alpert, John Mandrola","doi":"10.1016/j.amjmed.2025.06.021","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.021","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512686","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":"Punctate Diffusion-Restricted Lesion in Transient Global Amnesia.","authors":"Joseph Levine, Clement Lee","doi":"10.1016/j.amjmed.2025.06.038","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.038","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512689","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":"Artificial intelligence for identification of patients with increased risk of severe cancer therapy-related cardiac dysfunction following anthracycline therapy.","authors":"Isabel G Scalia, Juan M Farina, Milagros Pereyra Pietri, Patrick Sarkis, Niloofar Javadi, Nadera Naquib Bismee, Taylor Viggiano, Cecilia Tagle-Cornell, Laura Koepke, Courtney Kenyon, Barbara Novais, Mohammed Tiseer Abbas, Balaji K Tamarappoo, Steven J Lester, Imon Banerjee, Ramzi Ibrahim, Carolyn Larsen, Kwan S Lee, Reza Arsanjani, Chadi Ayoub","doi":"10.1016/j.amjmed.2025.06.035","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.035","url":null,"abstract":"<p><strong>Background: </strong>Early detection of cancer therapy-related cardiac dysfunction (CTRCD) after anthracycline exposure is critically important in minimizing morbidity and mortality. Artificial intelligence models applied to electrocardiograms (ECG-AI) may allow for early identification of CTRCD and improved outcomes.</p><p><strong>Methods: </strong>Patients treated with anthracyclines between 2002 and 2022 across three tertiary centers were evaluated. Characteristics, echocardiograms pre- and post-chemotherapy, and outcomes were reviewed. ECG-AI predictive scores for systolic dysfunction within one year following treatment were collected. ROC analysis was conducted for accuracy of ECG-AI score to detect severe CTRCD (left ventricular ejection fraction <40%).</p><p><strong>Results: </strong>Overall, 3439 patients were included, mean age 60.2 ± 14.1 years, 53.6% male. Severe CTRCD was present in 114 patients. ROC analysis of ECG-AI scores post-initiation of therapy was superior to that of pre-anthracycline ECG-AI scores and had moderate accuracy for detection of severe CTRCD (AUC 0.761). An ECG-AI score >3.0% was independently associated with significantly poorer survival at one year (HR 2.19, 95%CI 1.92-2.51) and five years (HR 1.69, 95%CI 1.54-1.87) post-anthracycline therapy.</p><p><strong>Conclusions: </strong>ECG-AI indicating increased likelihood for LVSD post-anthracycline therapy accurately detected severe CTRCD. Clinically, this tool may allow early diagnosis and treatment of high-risk patients and may reduce unnecessary surveillance in those with lower risk.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512684","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":"Outcomes of Oral Anticoagulation with Concomitant NSAID Use: A Registry Based Cohort Study.","authors":"Nelish Ardeshna, Josh Errickson, Xiaowen Kong, Mona A Ali, Naina Chipalkatti, Paul Dobry, Christopher Giuliano, Brian Haymart, Scott Kaatz, Jacob E Kurlander, Gregory D Krol, Sahana Shankar, Suman L Sood, James B Froehlich, Geoffrey D Barnes, Jordan K Schaefer","doi":"10.1016/j.amjmed.2025.06.034","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.034","url":null,"abstract":"<p><strong>Background: </strong>Concomitant use of oral anticoagulants (OACs) and nonsteroidal anti-inflammatory drugs (NSAIDs) is common despite concerns about increased bleeding risk. We sought to assess the frequency of co-administering NSAIDs for patients on OAC and the impact on clinical outcomes.</p><p><strong>Methods: </strong>We conducted a multicenter registry-based cohort study, utilizing 4:1 propensity score matching to compare patients on OAC monotherapy to those on OAC+NSAIDs therapy between 2011 and 2023 at six anticoagulation clinics of the Michigan Anticoagulation Quality Improvement Initiative. Adults on OAC for venous thromboembolism and/or atrial fibrillation were included. Patients with a history of heart valve replacement, under 3 months of follow-up, or using two or more antiplatelet drugs were excluded. The primary outcome was any bleeding. Secondary outcomes included bleeding subtypes, thrombosis/thromboembolism, healthcare utilization, and mortality.</p><p><strong>Results: </strong>Among the 12,083 patients receiving OAC, 449 (3.7%) were concurrently prescribed NSAIDs. The 1,796 patients on OAC monotherapy were compared to 449 patients on OAC+NSAID therapy after propensity matching. The matched groups were well balanced and followed for an average of 30 months. No significant differences were observed in bleeding event rates per 100 patient-years between the two groups, including overall (25.1 vs. 24.3, p= 0.56), major, and non-major bleeding. Rates of thrombosis, emergency room visits, hospitalizations, transfusion, and mortality were also similar.</p><p><strong>Conclusion: </strong>Clinical outcomes were similar between OAC monotherapy and OAC with concomitant NSAIDs use in this real-world observational study. As there are limited treatment options for pain further prospective research should be conducted to replicate these findings.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512687","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":"Pharmacogenomics: Clinical Progress.","authors":"Joseph S Alpert, Qin M Chen, Oleh Alex Mulyar, Tushar Acharya, Olivia Hung, Iniya Rajendran, Jan Lim, Ryan Freeman, Larissa Fedorova","doi":"10.1016/j.amjmed.2025.06.019","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.019","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512688","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":"Impact of Atherosclerotic Conditions and Cardiovascular Medications on Abdominal Aortic Aneurysm Growth.","authors":"Fahad Alkhalfan, Essa Hariri, Anu Aggarwal, Robert Burton, Bhairavi Rajasekar, Alliefair Scalise, Pulkit Chaudhury, Natalia Fendrikova Mahlay, A Phillip Owens, Scott J Cameron","doi":"10.1016/j.amjmed.2025.06.040","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.040","url":null,"abstract":"<p><strong>Background: </strong>While risk factors for atherosclerotic diseases and abdominal aortic aneurysms overlap, some risk factors, like diabetes, may slow aneurysm growth. The impact of atherosclerosis and its treatment on aneurysm growth is unknown. We aimed to investigate whether atherosclerotic conditions and cardiovascular medications are associated with faster aneurysm growth.</p><p><strong>Methods: </strong>Annualized abdominal aortic aneurysm growth rates were assessed over 10 years. The presence of coronary artery disease, peripheral artery disease, renal artery stenosis, and internal carotid artery stenosis was ascertained from vascular studies. Multivariable logistic regression models assessed the association between atherosclerotic conditions and fast aneurysm growth (≥0.5 cm/year). We further stratified by medication use, including aspirin.</p><p><strong>Results: </strong>Coronary artery disease, carotid artery stenosis, and renal artery stenosis were associated with reduced odds of fast aortic aneurysm growth, likely due to medications for treating these conditions. Aspirin was the only medication to show slower aneurysm growth regardless of disease co-morbidity. Patients with peripheral artery disease not managed by medications had faster aneurysm growth than those without peripheral artery disease. The addition of a Statin mediction was associated with a further reduction if fast aneurysm growth in patients with peripheral artery disease already taking aspirin.</p><p><strong>Conclusion: </strong>Atherosclerosis in vascular beds outside of the aorta was associated with a lower risk of fast aneurysm growth. Peripheral artery disease without pharmacological therapy had higher rates of fast aneurysm growth. Aspirin showed decreased aneurysm growth regardless of the co-incident vascular disease in patients with aortic aneurysms, highlighting the importance of appropriate pharmacological therapy.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512685","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 Clinician's Guide to Ethical Challenges in Discharge Planning: Proportionality, Risk, and Justice.","authors":"George Chengxi Bao, Sydney Katz, Debjani Mukherjee, Ezra Gabbay","doi":"10.1016/j.amjmed.2025.06.032","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.032","url":null,"abstract":"<p><p>Discharge planning often presents clinicians with ethical dilemmas. Because most clinicians lack formal training in ethics or have limited access to ethics consultation, we propose a pragmatic framework to address them. Our recommendations are based on a review of PubMed articles on ethics and adult inpatient discharge planning from January 2000 to May 2025. Ethical challenges can be categorized into two principal types: autonomy-related challenges, which arise when patients reject the clinical team's recommendations for safe discharge, and distributive justice-related challenges, which occur when resource allocation constraints affect discharge planning. Possible solutions emerge when applying the principle of proportionality to find a correct balance between the competing ethical principles of autonomy, beneficence, nonmaleficence, and justice. Such balance is inherently subjective, context-dependent, and arrived at through shared, deliberative decision-making. Finding proportionate balance is also error-prone, requiring continual reassessment through a reflective process that recognizes biases from healthcare policy and economic drivers.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509279","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":"\"Old Age Is Always 15 Years Older Than I Am\" ¹.","authors":"Joseph S Alpert","doi":"10.1016/j.amjmed.2025.06.020","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.06.020","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509278","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}