American Journal of Medicine最新文献

{"title":"Microbiomes in Health, Diseases and Therapeutics.","authors":"Edward J Goetzl","doi":"10.1016/j.amjmed.2025.09.002","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.09.002","url":null,"abstract":"<p><p>A microbiome is the aggregate of populations of bacteria, viruses and fungi in an organ system, of which the highly dominant numbers are in the gastrointestinal tract. Some of the bacteria, termed microbiota, support viability and functions of host cells directly by generating beneficial short-chain fatty acid components of dietary fibers and other metabolites of host compounds including secondary bile acids and indole derivatives of tryptophan. Short-chain fatty acids also recruit immune protective elements exemplified by IL-22, which has beneficial effects on intestinal epithelium by their IL-22 receptors. Other bacteria have detrimental effects on host cells through lipopolysaccharides and diverse toxins. An increased ratio of detrimental to beneficial microbiomal bacteria, a state termed dysbiosis, is observed in human diseases of many systems. Therapies for dysbiosis involve largely dietary manipulation and more recently fecal microbiota transplantation. Resistant and recurrent Clostridium difficile diarrhea responds dramatically to fecal microbiota transplantation, but this approach requires additional evaluation in other diseases. The potential prognostic value of microbiome characteristics suggests future uses in precision medicine.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139246","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":"AAIM Recommendations for Post-Core Clerkship Clinical Rotations to Prepare for Residency in Internal Medicine.","authors":"Lauren M DiMarino, Uma S Ayyala, Adam Garber, John H Choe, Reeni Abraham, Paul O'Rourke, Kathleen Cooney, Ricardo Correa, Catherine Apaloo, Amber T Pincavage","doi":"10.1016/j.amjmed.2025.09.003","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.09.003","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132428","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 Reply","authors":"Edward J. Goetzl MD ,&nbsp;Brian Feeley MD","doi":"10.1016/j.amjmed.2025.05.046","DOIUrl":"10.1016/j.amjmed.2025.05.046","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":"138 10","pages":"Page e219"},"PeriodicalIF":5.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108708","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 Reply","authors":"Matthew D. Weaver PhD ,&nbsp;Laura K. Barger PhD ,&nbsp;Charles A. Czeisler PhD, MD ,&nbsp;Christopher P. Landrigan MD, MPH","doi":"10.1016/j.amjmed.2025.06.013","DOIUrl":"10.1016/j.amjmed.2025.06.013","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":"138 10","pages":"Pages e215-e217"},"PeriodicalIF":5.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109069","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 Review of Musculoskeletal Disorders Should Also Include Diseases of the Peripheral Nerves and Skeletal Muscles","authors":"Josef Finsterer MD, PhD","doi":"10.1016/j.amjmed.2025.05.031","DOIUrl":"10.1016/j.amjmed.2025.05.031","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":"138 10","pages":"Page e218"},"PeriodicalIF":5.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108890","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":"Request for Further Analysis of EDS Trends in Residency Training","authors":"Tatsuhiko Nanri MD,&nbsp;Kota Minami MD,&nbsp;Ayako Watanabe MD,&nbsp;Mitsuhiro Fukuda MD,&nbsp;Torahiko Nanri MD","doi":"10.1016/j.amjmed.2025.05.003","DOIUrl":"10.1016/j.amjmed.2025.05.003","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":"138 10","pages":"Page e214"},"PeriodicalIF":5.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109068","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":"Job satisfaction: Which jobs fare best and worst?","authors":"Joseph S Alpert","doi":"10.1016/j.amjmed.2025.09.001","DOIUrl":"10.1016/j.amjmed.2025.09.001","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076616","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 Daily Personal Communication on Hospital Readmissions: A Case-Control Study.","authors":"Liat Lipski-Pozitzki, Anne Marie Novak, Rachel Heffez Ayzenfeld, Yair Levy, Danny Alon, Michael Lishner, Shahar Lev-Ari","doi":"10.1016/j.amjmed.2025.08.021","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.08.021","url":null,"abstract":"<p><strong>Background: </strong>Recurrent hospitalizations present significant financial burdens and health risks. Poor communication and lack of personalized care are major contributors to preventable readmissions. This study examined whether brief, personal conversations between physicians and hospitalized -patients could reduce 1-week and 30-days post-discharge readmissions, and improve satisfaction.</p><p><strong>Methods: </strong>This prospective, case-control study involved 459 patients hospitalized in Internal Medicine Wards at a general hospital in Israel. Patients 18-100 years were included, excluding those with dementia, limited communication abilities, or discharge within 24-hours. The intervention group engaged in brief, personal conversations with physicians. Comparison group patients were hospitalized concurrently in other wards and received standard care. Eleven physicians received 1.5-hours of training, and conducted 3-5 minute personal conversations with patients daily, supplementing standard care. Readmissions within 7- and 30-days post-discharge and patient satisfaction were measured.</p><p><strong>Results: </strong>The intervention (n=249) and comparison groups (n=210) had similar baseline characteristics except that the intervention group was older (66.7 vs. 62.7 years, p=.008). Multivariable logistic regression showed significantly reduced odds of readmission in the intervention group at both 1 week (OR 0.33, 95% CI 0.16-0.66, p = .002) and 30 days (OR 0.54, 95% CI 0.34-0.88, p = .012), after adjusting for covariates including age, diagnosis severity, satisfaction, and sociodemographic factors.</p><p><strong>Conclusions: </strong>Readmission rates were decreased after brief, personal physician-patient conversations. These findings support integrating personalized communication strategies into standard care to improve outcomes. Future research should confirm these finding in larger samples and explore optimal frequency and duration of such interactions.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016597","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":"Ultra-processed foods and increased high sensitivity C-reactive protein.","authors":"Kevin Sajan, Nishi Anthireddy, Alexandra Matarazzo, Caio Furtado, Charles H Hennekens, Allison Ferris","doi":"10.1016/j.amjmed.2025.08.016","DOIUrl":"10.1016/j.amjmed.2025.08.016","url":null,"abstract":"<p><strong>Objective: </strong>This work is intended to explore whether people with increased consumption of ultra-processed foods have significantly increased high sensitivity C-reactive protein (hs-CRP), a sensitive inflammatory marker and accurate predictor of cardiovascular disease.</p><p><strong>Methods: </strong>United States (US) National Health and Nutrition Examination Survey, a nationally representative sample of 9,254 that included ultra-processed foods as percentage of total energy intake using the validated NOVA classification system. We used means and percentages as measures of effect, and 95% confidence intervals (CI) (P<0.05) to test for significance. Logistic regression analyses used Python 3.12 and the statsmodels package.</p><p><strong>Results: </strong>Participants had a median energy intake of 35.0% from ultra-processed foods, from 0-19% in the lowest quartile to 60-79% in the highest. The median age was 38.0; 51.8% were women. 27.3% had elevated hs-CRP (≥3 mg/L), with a mean of 1.4 mg/L; 13.1% were current smokers (95% CI: 11.4-15.1%), and 57.2% had no physical activity (95% CI: 55.7-58.7%). After adjusting for these confounders, compared with those consuming 0-19% ultra-processed foods, individuals with 60-79% had significantly increased hs-CRP [RR= 1.11 (95% CI: 1.01-1.21, P<0.05)]. Individuals with 40-59% intake also had a significantly increased hs-CRP [(RR= 1.14 (95% CI: 1.03-1.27, P<0.05)]. There was a nonsignificant 7% increase among those consuming 20-39% ultra-processed foods [RR=1.07 (0.98-1.16, P=ns)].</p><p><strong>Conclusions: </strong>These data from a large and representative US sample show that those consuming the highest amounts of ultra-processed foods have significantly elevated levels of hs-CRP. The findings have major clinical and public health as well as research implications.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006755","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":"Adverse Effects of Health Plan Prior Authorization on Clinical Effectiveness and Patient Outcomes: A Systematic Review.","authors":"Jacob Murphy, Norman Beauchamp, Kristi J Sun, Brandyn D Lau, Renee F Wilson, Katie Lobner, Sarah J Conway, Peter M Hill, Pamela T Johnson","doi":"10.1016/j.amjmed.2025.08.018","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.08.018","url":null,"abstract":"<p><p>Prior authorization requirements by health insurance plans have become a barrier to healthcare delivery in the United States in terms of clinical efficiency, patient and provider experience. Surveyed physicians report associations with care delays, reduced clinical effectiveness and compromised patient outcomes. In this systematic review, we synthesized the published evidence regarding harmful effects of prior authorization on disease management and patient outcomes. Twenty-five studies were included. In addition to care delays, authorization requirements were associated with disease exacerbation, preventable hospitalization, prolonged hospital stay, and lower rates of disease-free survival. Studies spanned multiple specialties including oncology, cardiology, behavioral health and pediatrics. Published evidence shows that prior authorization requirements are associated with measurable patient harm across multiple healthcare domains. Recognizing that a small number of retrospective studies do not adequately quantify the harm, we propose establishing national quality metrics for health plans, using claims data to track longitudinal outcomes in patients subject to delays and denials.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006760","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}