American Journal of Medicine最新文献

{"title":"Preventing and responding to medical gaslighting: recommendations for providers and patients.","authors":"Devora Shapiro, Anna Hayburn","doi":"10.1016/j.amjmed.2025.08.022","DOIUrl":"10.1016/j.amjmed.2025.08.022","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001850","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":"Tom's chart.","authors":"Timothy N Liesching","doi":"10.1016/j.amjmed.2025.08.026","DOIUrl":"10.1016/j.amjmed.2025.08.026","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994084","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":"Optimizing guideline-directed medical therapy in chronic kidney disease and type 2 diabetes mellitus patients in primary care.","authors":"Rosalba Santana, Chinweizu Deborah Umana, Zin Thawdar Oo, Shiny Teja Kolli, Vishal Reddy Bejugam, Shobhit Piplani, Amr Aljareh, Bruna Taveras Garcia, Dimitrios Raptis, Chisom Asuzu, Sonam Kumari, Sung Mi Yoon, Archana Vashisht, Meryl Waldman, Vimala Ramasamy, Belinda Jim","doi":"10.1016/j.amjmed.2025.08.029","DOIUrl":"10.1016/j.amjmed.2025.08.029","url":null,"abstract":"<p><strong>Background: </strong>Despite KDIGO (Kidney Disease: Improving Global Outcomes) recommendations for renin-angiotensin-aldosterone system inhibitors (RAASi's) and sodium-glucose cotransporter-2 inhibitors (SGLT2i's) as first-line medications in chronic kidney disease and Type 2 diabetes mellitus patients, implementation gaps persist. We aimed to identify the reasons behind these gaps and develop strategies to address them.</p><p><strong>Methods: </strong>We conducted a retrospective study examining RAASi and SGLT2i prescription patterns among chronic kidney disease and Type 2 diabetes mellitus patients at an inner-city community hospital. Primary care providers were surveyed about barriers to prescribing these medications, after which we implemented an educational intervention and reassessed prescription rates.</p><p><strong>Results: </strong>We identified hyperkalemia and estimated glomerular filtration rate (eGFR) below 30 ml/min/1.73m² as major barriers to initiating RAASi's while hyperkalemia and acute kidney injury were the primary limiting factors for medication continuation. Insurance coverage and medication intolerance were the main obstacles to initiating and continuing SGLT2i's respectively. Prior hyperkalemia significantly reduced the odds ratio of RAASi prescription (P = 0.01) whereas urine albumin-creatinine ratio (UACR) screening significantly increased them (P = 0.03). UACR screening within the past year was associated with higher odds of SGLT2i prescription rates (P = 0.019) while insurance status showed no statistically significant impact (P = 0.317). Following educational intervention, annual UACR screening increased by 44%, while prescription rates for SGLT2i's and RAASi's increased by 95% and 4%, respectively. These increased rates were distributed proportionally across racial and ethnic groups.</p><p><strong>Conclusions: </strong>We demonstrated that targeted educational interventions can improve evidence-based care delivery in a racially and ethnically equitable manner. Future research should explore artificial intelligence-based implementation strategies and conduct outcome-based studies.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994145","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":"Armor, vulnerability, and connectedness: Exploring humanism in the middle of residency.","authors":"David Szarvas, Parker Yount","doi":"10.1016/j.amjmed.2025.08.034","DOIUrl":"10.1016/j.amjmed.2025.08.034","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993548","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 Practical Approach to the Diagnosis and Management of Hepatic Encephalopathy.","authors":"Nancy Reau, David Bernstein, Paul Kwo, Michelle Loftus, Ann Moore, Sammy Saab","doi":"10.1016/j.amjmed.2025.08.041","DOIUrl":"https://doi.org/10.1016/j.amjmed.2025.08.041","url":null,"abstract":"<p><p>A Practical Approach to the Diagnosis and Management of Hepatic Encephalopathy] Hepatic encephalopathy (HE) is a common complication of decompensated cirrhosis that can be reversed with treatment. Frequent episodes of recurrence are common, impacting patients, caregivers and healthcare systems, increasing morbidity and mortality statistics and resulting in grave financial consequences. Uptake and adherence to formal recommendations for HE diagnosis and management are low. There is an unmet need to advocate for the use of these recommendations in a more pragmatic form. Clinicians from multiple disciplines, dedicated to raising liver disease awareness, convened in a roundtable format to review and discuss the latest HE guidelines and relevant peer-reviewed literature on HE. The result was this clinical care publication on the screening, diagnosis and management of HE which seeks to facilitate clinicians' recognition and diagnosis of HE, apply a pathway of care for HE that addresses steps for initial management, long-term maintenance and prevention; it also addresses practical recommendations concerning situations encountered in HE. Resources are provided to address the different needs of the three key players in HE: patients, caregivers, and healthcare professionals. [Text for: A Practical Approach to the Diagnosis and Management of Hepatic Encephalopathy].</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993443","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":"Hoagland sign as the first manifestation of intrahepatic cholangiocarcinoma in a young Chinese woman.","authors":"Yuichi Takahashi, Taro Kunitomi, Yuichiro Mine, Gautam A Deshpande, Toshio Naito","doi":"10.1016/j.amjmed.2025.08.039","DOIUrl":"10.1016/j.amjmed.2025.08.039","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993708","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":"Long-term aspirin use and heart failure incidence: A patient-level pooled analysis study.","authors":"Mianli Xiao, Zailing Xing, Douglas D Schocken, Janice C Zgibor, Amy C Alman","doi":"10.1016/j.amjmed.2025.08.025","DOIUrl":"10.1016/j.amjmed.2025.08.025","url":null,"abstract":"<p><strong>Background: </strong>The effect of chronic aspirin use on the development of heart failure remains uncertain, and no prior observational study has evaluated it as a time-dependent exposure.</p><p><strong>Methods: </strong>We analyzed data from four prospective cohort studies involving 26,941 individuals free of cardiovascular disease but at risk for heart failure. The baseline mean age was 60.7 years; 55.6% were female and 65.4% were White. Time-dependent information on aspirin use and heart failure risk factors was systematically collected, and participants were longitudinally followed for incident heart failure. Using the parametric g-formula, we estimated the effect of two hypothetical interventions-consistent aspirin use and never using aspirin-on heart failure incidence. Covariates included baseline age, sex, race, smoking, alcohol consumption, study-related factors, and time-dependent variables such as body mass index, systolic blood pressure, low-density lipids, triglycerides, blood glucose, creatinine, and medication use (anti-hypertensive, anti-diabetic, lipid-lowering, and anticoagulant).</p><p><strong>Results: </strong>Over a median follow-up of 14.8 years (IQR: 8.5-22.5), 5,899 heart failure cases occurred. At year 32, as estimated by the model and compared with the natural course (no intervention), continuous aspirin use increased heart failure risk by 7% (risk ratio [RR] 1.07, 95% CI 1.05-1.08), while never using aspirin decreased risk by 6% (RR 0.94, 95% CI 0.92-0.95). These effects persisted in subgroup analyses by sex and by baseline age (<60/≥60 years).</p><p><strong>Conclusion: </strong>Long-term aspirin use increased the risk of heart failure in individuals free of cardiovascular disease, as estimated through a hypothetical intervention using the g-formula.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977425","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":"Tracheal injury after intubation.","authors":"Fumu Wang, Haiming Wang","doi":"10.1016/j.amjmed.2025.08.023","DOIUrl":"10.1016/j.amjmed.2025.08.023","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977464","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":"Paget-Schroetter syndrome without obvious triggers.","authors":"Yoshihito Mima, Masako Yamamoto, Ken Iozumi","doi":"10.1016/j.amjmed.2025.08.036","DOIUrl":"10.1016/j.amjmed.2025.08.036","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977455","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":"Urban brucellosis risk: A hidden threat of pet companionship.","authors":"Wilson Gw Goh, Isaac Ks Ng, Stella Km Chan, Priscillia Ps Lye, Sai Meng Tham","doi":"10.1016/j.amjmed.2025.08.033","DOIUrl":"10.1016/j.amjmed.2025.08.033","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977522","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}