American Journal of Medicine最新文献

{"title":"Extended Thromboprophylaxis in Patients Hospitalized with COVID-19 at Time of Discharge is Not Associated with Improvement in Quality of Life.","authors":"Lana Wahid, Taeim Kwon, Lisa Baumann Kreuziger, Raj S Kasthuri, Peter J Miller, Tracy Y Wang, Kevin J Anstrom, Thomas L Ortel","doi":"10.1016/j.amjmed.2025.06.003","DOIUrl":"10.1016/j.amjmed.2025.06.003","url":null,"abstract":"<p><strong>Background: </strong>The long-term effects of COVID-19, known as post-acute sequelae of SARS-CoV-2 infection (PASC), impair quality of life (QoL). This secondary analysis of the ACTIV-4c clinical trial evaluates the specific effects of extended thromboprophylaxis with apixaban on individual QoL domains, assessed by EQ-5D-5L index, in patients discharged after COVID-19 hospitalization.</p><p><strong>Methods: </strong>ACTIV-4c study was a prospective randomized, placebo-controlled, double-blind clinical trial. We enrolled 1,217 patients hospitalized with COVID-19 at 107 U.S. hospitals between February 2021 and June 2022. Participants were randomized to apixaban 2.5 mg twice daily or placebo for 30 days post-discharge. QoL was assessed using EQ-5D-5L index at 2, 30, and 90 days post-discharge, evaluating five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Data were analyzed using chi-square tests and proportional odds models adjusted for multiple variables.</p><p><strong>Results: </strong>Of 1,217 participants, 610 received apixaban and 607 received placebo. By 2 days post-discharge, 43.5% of apixaban and 45.0% of placebo recipients reported moderate impairment in one or more EQ-5D-5L domains, particularly usual activities (33.0%). At 30 days, moderate impairment persisted in 30.8% of apixaban and 33.4% of placebo recipients, improving most in the usual activities domain (17.4%). At 90 days, 31.5% of apixaban and 28.5% of placebo recipients reported moderate impairment. Extended thromboprophylaxis with apixaban was not associated with significant improvements in any EQ-5D-5L domains at 30 or 90 days.</p><p><strong>Conclusions: </strong>Extended thromboprophylaxis with apixaban after COVID-19 hospitalization does not improve QoL. The high prevalence of QoL impairment highlights the need for targeted interventions for PASC.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295283","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":"Internal Medicine Residency Point-of-Care Ultrasound (POCUS) Consensus Recommendations for Core Indications and Applications.","authors":"Charles M LoPresti, Kevin J Murray, Ria Dancel, Cameron Baston, Brandon Boesch, David Brennan, Apostolos P Dallas, Renee Dversdal, Timothy Flynn, Ricardo A Franco Sadud, Trevor P Jensen, Benji K Mathews, Nilam J Soni, Kang Zhang, David M Tierney","doi":"10.1016/j.amjmed.2025.05.033","DOIUrl":"10.1016/j.amjmed.2025.05.033","url":null,"abstract":"<p><strong>Background: </strong>Bedside point-of-care ultrasound (POCUS) is quickly becoming a routine part of internal medicine practice and training. The optimal POCUS training venue for internists is at the graduate medical education or residency stage of their career. Despite increased training, clinical use, and broad internal medicine society endorsement in the United States, no internal medicine POCUS consensus curricula exist. The goal of this consensus process was to guide the core elements for inclusion within internal medicine residency POCUS curricula in the United States.</p><p><strong>Methods: </strong>A 4-step modified Delphi methodology was used to establish consensus (75% agreement) recommendations for core indications and applications among a panel of 14 inpatient- and outpatient-based, residency-affiliated, internal medicine POCUS experts in the United States.</p><p><strong>Results: </strong>The consensus process identified 12 core diagnostic and 6 procedural POCUS indications (eg, dyspnea, shock, chest pain, thoracentesis, etc.), with an associated 15 diagnostic POCUS applications (eg, focused cardiac, gallbladder, urinary bladder, etc.) and 52 specific skill components (eg, identification of pericardial effusion, cholelithiasis, bladder volume, etc.) that reached consensus for inclusion in core curricula.</p><p><strong>Conclusions: </strong>This consensus process represents the first expert and evidence-based recommendation for what POCUS elements should fall into a core internal medicine residency-based curriculum in the United States. Many areas not meeting consensus for inclusion still fall within the broader internal medicine POCUS scope and can be clinically impactful for specific subgroups of internists, such as advanced internal medicine POCUS users, and specific inpatient and outpatient clinical environments.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286958","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 Decade of Hypnotherapy Research for Multiple Sclerosis Symptom Management: A Systematic Review.","authors":"Ahmet Onat Özdemir, Mauro Cozzolino, Osman Gürdal, Ivonne Carosi Arcangeli, Stefania Mancone, Giovanna Celia","doi":"10.1016/j.amjmed.2025.05.049","DOIUrl":"10.1016/j.amjmed.2025.05.049","url":null,"abstract":"<p><p>This systematic review investigates the effectiveness of hypnotherapy for symptom control in multiple sclerosis (MS) patients. Following PRISMA guidelines, eight research participants (N=423, sample sizes 15-173) were assessed using the PEDro scale. Hypnotherapy showed significant benefits, including a 30-45% reduction in pain intensity (p<0.01), an 8.19 point decrease in Multidimensional Fatigue Inventory scores (p<0.05), a 1.98-point improvement in Pittsburgh Sleep Quality Index scores (P<0.05), and a 3.7-point reduction in DASS-21 depression subscale. Optimal protocols included 8-10 weekly 45-60-minute sessions, with coupled treatments (hypnotherapy with neurofeedback or mindfulness) producing better results (additional 15-20% improvement). Follow-ups revealed that psychological advantages persisted, although pain alleviation decreased after 6 months without maintenance. The evidence suggests that hypnotherapy can be an effective additional strategy for MS symptom management, with hypnotic cognitive treatment exhibiting notable efficacy for tiredness and psychosocial problems. Methodological limitations demand larger trials with standardized methodologies.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286956","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 Integrative Approach to HPA Axis Dysfunction: From Recognition to Recovery.","authors":"Melinda Ring","doi":"10.1016/j.amjmed.2025.05.044","DOIUrl":"10.1016/j.amjmed.2025.05.044","url":null,"abstract":"<p><strong>Objectives: </strong>The hypothalamic-pituitary-adrenal (HPA) axis plays a central role in the body's stress response and is increasingly recognized as a contributor to a range of chronic health conditions. This review aims to provide an evidence-based overview of HPA axis dysregulation, including its underlying mechanisms, diagnostic approaches, and integrative treatment strategies.</p><p><strong>Methods: </strong>A comprehensive review of peer-reviewed literature was conducted to examine the multifactorial contributors to HPA axis dysfunction. Sources included studies on psychological stress, dietary and lifestyle factors, genetic and epigenetic influences, immune system interactions, gut health, inflammation, environmental toxins, and hormonal imbalances. Diagnostic modalities such as serum and salivary cortisol testing were also reviewed.</p><p><strong>Results: </strong>HPA axis dysfunction is influenced by a complex interplay of internal and external stressors, including chronic psychological stress, dietary imbalances, disrupted circadian rhythms, and environmental exposures. Diagnostic methods vary in sensitivity and clinical utility, with diurnal salivary cortisol profiles offering insight into functional patterns. Integrative treatment approaches include patient-centered care, mind-body therapies, dietary and lifestyle interventions, targeted nutraceuticals, and adaptogenic herbs-each aimed at restoring balance and improving stress resilience.</p><p><strong>Conclusions: </strong>Understanding HPA axis dysregulation through an integrative lens supports a more individualized and comprehensive approach to care. By bridging conventional endocrinology and functional medicine, clinicians are better equipped to address commonly overlooked symptoms such as fatigue, insomnia, mood disturbances, and poor stress tolerance, ultimately enhancing patient outcomes.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276539","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":"Elevated Lipoprotein(a): A Treatment Challenge and a Practical Solution.","authors":"David S Schade, Allen Adolphe, Samuel Wann, Robert Philip Eaton","doi":"10.1016/j.amjmed.2025.05.035","DOIUrl":"10.1016/j.amjmed.2025.05.035","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250598","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 Dual Antiplatelet Therapy Duration on Long-Term Outcomes Following Chronic Total Occlusion Percutaneous Coronary Intervention.","authors":"Yao Jiang, Han Zhang, Chujie Zhang, Yingyang Geng, Yin Zhang, Changdong Guan, Kefei Dou, Yuejin Yang, Shubin Qiao, Yongjian Wu, Lei Song","doi":"10.1016/j.amjmed.2025.05.038","DOIUrl":"10.1016/j.amjmed.2025.05.038","url":null,"abstract":"<p><strong>Background: </strong>Optimal dual antiplatelet therapy (DAPT) duration after percutaneous coronary intervention for coronary chronic total occlusion remains unclear. Thus, we aim to determine the optimal DAPT duration in this high-risk cohort with complex anatomy and procedures.</p><p><strong>Methods: </strong>Between January 2010 and December 2013, 2659 consecutive chronic total occlusion patients undergoing percutaneous coronary intervention at Fuwai Hospital were enrolled, and those without adverse events within 12 months were categorized into long-term (>12 months) or short-term (≤12 months) groups according to DAPT duration. The primary endpoint was a composite of cardiac deaths and spontaneous myocardial infarction at 5 years. The safety endpoint was the rate of Bleeding Academic Research Consortium (BARC) 2, 3, or 5 type bleeding at 5 years.</p><p><strong>Results: </strong>Overall, 1923 patients were included in the final analysis, of which 1104 (57.4 %) continued DAPT beyond 12 months. Compared with short-term DAPT, long-term DAPT was associated with a lower rate of primary outcome (3.6 % vs 6.3 %; adjusted hazard ratio [aHR] 0.58; 95 % confidence interval [CI], 0.38-0.89, P = .01), primarily driven by fewer cardiac death (0.1 % vs 4.0 %, aHR 0.02; 95 % CI, 0.00-0.17; P < .001) and a higher risk of BARC 2-5 bleeding (3.8 % vs 1.5 %; aHR 2.61; 95 % CI, 1.37 to 4.97, P < .01), whereas the risk of BARC 3 or greater was comparable between groups.</p><p><strong>Conclusion: </strong>In patients undergoing chronic total occlusion percutaneous coronary intervention, prolonged DAPT was associated with a reduced risk of cardiac death and myocardial infarction, but with an increased risk of minor bleeding.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250599","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 and Value in AI-Driven Medicine.","authors":"Ruchi Bhatia","doi":"10.1016/j.amjmed.2025.06.001","DOIUrl":"10.1016/j.amjmed.2025.06.001","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250601","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 Call for Health Care Providers to Address Faith, Religiosity, and Spirituality among Older Adults.","authors":"Hawa O Abu","doi":"10.1016/j.amjmed.2025.05.048","DOIUrl":"10.1016/j.amjmed.2025.05.048","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250597","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":"Physician Mental Health: Understanding Physician Burnout and Solutions for Well-Being.","authors":"Diana Hsiao, Adithi A Tirumalai, Justina John, Sohum Sheth, Beth Frates, Dean Ornish, Monica Aggarwal","doi":"10.1016/j.amjmed.2025.05.039","DOIUrl":"10.1016/j.amjmed.2025.05.039","url":null,"abstract":"<p><p>Physician burnout has become increasingly prevalent in the United States, and it has significant consequences on the patient, physician, and health care system levels. Increasing physician burnout has led to greater physician turnover rates, medical errors, and financial burdens on our health care system. This review of physician mental health and burnout discusses key contributing factors, potential solutions, and investigates the benefits of love, social connection, and joy. This paper also addresses burnout specific to female physicians and compares burnout by subspecialty. Understanding the root causes of physician burnout can help us implement meaningful change to mitigate the consequences by reducing stigma, fostering resilience strategies, improving quality of life for physicians, enhancing patient care, and reducing the financial strain on health care systems.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250600","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 Performance of Biomarkers for the Diagnosis of Parkinson Disease: A Systematic Review.","authors":"Jaden Lim, Yeonglong Ay","doi":"10.1016/j.amjmed.2025.05.047","DOIUrl":"10.1016/j.amjmed.2025.05.047","url":null,"abstract":"<p><strong>Background: </strong>Early diagnosis of Parkinson disease remains challenging due to the current clinical diagnostic approach. With machine learning emerging as a powerful tool for biomarker discovery, we aimed to determine whether biomarkers processed by machine learning models can enable earlier detection of Parkinson disease.</p><p><strong>Methods: </strong>We conducted a literature search with a 10-year limit that yielded 161 biomarkers derived from serum, cerebrospinal fluid, and genes. Initially, biomarkers were classified into 4 groups according to the biological timeline of Parkinson disease pathogenesis. Subsequently, we further organized the biomarkers into 2 categories: pre-motor phase and motor phase biomarkers. Two analyses were then conducted according to the aforementioned classifications, with the performance of biomarkers evaluated via their area under the curve values as derived from machine learning models.</p><p><strong>Results: </strong>No significant differences were found in either analysis, suggesting that all biomarkers, regardless of their role in the biological sequences underpinning Parkinson disease pathogenesis, and their association with the pre-motor or motor phases of Parkinson disease, have the potential to serve as equally valid diagnostic predictors. Additionally, we identified 26 top-performing biomarkers with high area under the curve values (>0.8).</p><p><strong>Conclusions: </strong>The main finding in our analyses was that pre-motor phase biomarkers, which offer the advantage of enabling an earlier diagnosis compared with clinical methods, can achieve a comparably high level of diagnostic accuracy as motor phase biomarkers. Therefore, our foremost suggestion is further research into the clinical viability of pre-motor phase biomarkers that compose part of the aforementioned 26 top-performing biomarkers.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235848","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}