American journal of medicine open最新文献

{"title":"Comparisons of risk factors and outcomes between abdominal aortic aneurysm and peripheral arterial disease: a case-control study","authors":"Ian Beeton ,&nbsp;Jay Acharya ,&nbsp;Bengisu Kesin Meric ,&nbsp;James Hobden ,&nbsp;Tahir Ali ,&nbsp;Thang S. Han","doi":"10.1016/j.ajmo.2025.100087","DOIUrl":"10.1016/j.ajmo.2025.100087","url":null,"abstract":"<div><h3>Background</h3><div>There is a paucity of data on direct comparison of clinical measures in patients with abdominal aortic aneurysm (AAA) and those with peripheral arterial disease (PAD). Here, we examine the risk factors and outcomes between these 2 conditions.</div></div><div><h3>Methods</h3><div>Group differences were examined by Fisher's exact tests with Bonferroni correction, postoperative complications (including delirium and pneumonia) and LOS by logistic regression, and mortality by Cox regression, adjusted for age, sex, smoking, co-morbidities and medications.</div></div><div><h3>Results</h3><div>In total, 160 men and 33 women aged 74.5years (SD = 9.4) were referred for preoperative cardiac assessment for AAA (<em>n</em> = 70) and PAD (<em>n</em> = 123). Vascular surgery was performed in 148 patients (70% of AAA; 80.5% of PAD). Myocardial infarct was more prevalent in AAA, and diabetes more in PAD, whilst atrial fibrillation, stroke, congestive heart failure and hypertension did not differ between groups. Compared to patients with PAD, there were higher proportions of patients with AAA prescribed with cardiovascular medications, and developed post-operative complications in hospital: odds ratio = 7.34 (95% CI, 2.26-23.84, <em>P</em> &lt; .001), and stayed in hospital &gt;1week: odds ratio = 2.60 (95% CI, 1.15-5.85, <em>P</em> = .021). Compared to those with AAA, patients with PAD were at greater risk of death in the entire sample: hazard ratio = 3.34 (95% CI, 1.64-6.79), and in those who underwent vascular surgery: hazard ratio = 4.90 (95% CI, 1.88-12.79). Left ventricular function did not relate to outcomes.</div></div><div><h3>Conclusions</h3><div>Differences between AAA and PAD in risk profile and management which may have a bearing on higher risk of death associated with PAD. More intensive cardiovascular management may help improve their outcomes.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100087"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a New Malnutrition Screening Tool for Patients: Human Key Tool of Nutrition","authors":"Kotono Oishi MSc,&nbsp;Arisa Inoue-Hamano PhD,&nbsp;Yasuhiro Hamada MD,PhD","doi":"10.1016/j.ajmo.2024.100086","DOIUrl":"10.1016/j.ajmo.2024.100086","url":null,"abstract":"<div><h3>Background and aims</h3><div>Malnutrition is related to increased mortality and poor outcome. Therefore, early diagnosis and intervention of malnutrition are recommended. However, the optimal nutrition screening tool for diagnosing malnutrition remains undetermined. This study aimed to verify the discrimination and difficulty of nutrition screening items through item response theory (IRT) analysis and develop a simpler malnutrition screening tool.</div></div><div><h3>Methods</h3><div>This study enrolled 10,375 patients aged ≥18 years who were admitted at Tokushima University Hospital. Patients who were pregnant had short-term hospitalization (≤3 days), were hospitalized only in the weekend, could not hear clearly, and were hospitalized merely for examination were excluded. A skilled dietitian performed the Subjective Global Assessment, rating a good nutritional status as A, moderate malnutrition as B, and severe malnutrition as C.</div></div><div><h3>Results</h3><div>According to Subjective Global Assessment, we classified 7119 patients as A, 2892 as B, and 364 as C. Between these classes, the total number of application items was significantly lower in class A but significantly higher in class C. In the discrimination of each item calculated by IRT analysis, the highest discrimination item was “Has your food intake been less than usual?”, followed by “Have you had anorexia?”, “Have you had vomiting?”, “Have you had nausea?”, “Have you had dehydration?”, and “Have you lost weight?”.</div></div><div><h3>Conclusions</h3><div>Human Key Tool of Nutrition, which is based on the IRT analysis results, is a new simple nutrition screening tool developed by us. Human Key Tool of Nutrition can contribute to the widespread use of nutrition screening.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100086"},"PeriodicalIF":0.0,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyponatremia with an Osmolar Gap, Pseudohyponatremia or Hyper-Osmolar Hyponatremia?","authors":"Leonardo Pozo Garcia ,&nbsp;Livia Frost ,&nbsp;Bryan M. Tucker","doi":"10.1016/j.ajmo.2024.100081","DOIUrl":"10.1016/j.ajmo.2024.100081","url":null,"abstract":"<div><div>Pseudohyponatremia is frequently misunderstood and often mistaken for other types of hyponatremia. In this study, we present a case of pseudohyponatremia resulting from hypertriglyceridemia. We provide an in-depth analysis of the pathophysiological mechanisms involved, comparing them with those of other hyponatremic disorders, and outline the diagnostic approach used to identify this atypical form of hyponatremia. Recognizing and accurately diagnosing non–hypo-osmolar hyponatremia is paramount, as these conditions are treated differently than other forms of hyponatremia.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gun-related mortality in children- seeing past geography","authors":"Stuart R. Chipkin MD","doi":"10.1016/j.ajmo.2022.100021","DOIUrl":"10.1016/j.ajmo.2022.100021","url":null,"abstract":"","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"12 ","pages":"Article 100021"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48633831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The David Sign, Revisited","authors":"Daniel M. Gelfman MD","doi":"10.1016/j.ajmo.2023.100061","DOIUrl":"10.1016/j.ajmo.2023.100061","url":null,"abstract":"<div><div>This commentary discusses a new, previously unrecognized, undocumented, anatomic finding concerning the jugular venous distention present on one of the world’s most famous statues, Michelangelo’s David. This finding is provocative as it involves of one of Michelangelo’s “messages” being demonstrated in The David, has clinical relevance, and, appears to reveal something about Michelangelo, himself.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"12 ","pages":"Article 100061"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136152418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of a Nutritional Risk Assessment Tool to Guide Early Enteral Nutrition among Mechanically Ventilated Trauma Patients","authors":"Julia Heizmann ,&nbsp;Christopher Gross ,&nbsp;Chelsea Yap ,&nbsp;Mary Anne Walling ,&nbsp;Moya Reid ,&nbsp;Albert Hsu ,&nbsp;Marie Crandall ,&nbsp;Jin Ra","doi":"10.1016/j.ajmo.2024.100080","DOIUrl":"10.1016/j.ajmo.2024.100080","url":null,"abstract":"<div><h3>Background</h3><div>The Modified Nutritional Risk in Critically Ill (mNUTRIC) score has been proposed as a tool to identify hospitalized patients at risk for malnutrition who may benefit from early enteral nutrition (EN) therapy.</div></div><div><h3>Objective</h3><div>Our goal was to determine if mNUTRIC scores could predict, at time of intensive care unit admission, which mechanically ventilated trauma patients were at risk for malnutrition and might benefit from early EN, as indicated by reduced mortality.</div></div><div><h3>Methods</h3><div>We conducted a retrospective chart review of all adult trauma patients requiring mechanical ventilation for at least 48 hours between 01/21/2012 and 12/31/2016, reviewing inpatient medical records, demographic data, disease markers, injury severity, and comorbidities. Bivariate statistics and multivariate regression analyses were used to investigate the correlation between time of EN initiation and mortality rates, as well as the relationship of mNUTRIC scores with EN commencement with early EN initiation being ≤48 hours and malnutrition risk mNUTRIC ≥5.</div></div><div><h3>Results</h3><div>Among 931 patients reviewed, bivariate analysis showed higher mNUTRIC scores correlated with older, sicker patients and higher mortality. However, multivariate analysis revealed no significant association between higher mNUTRIC scores and increased mortality (OR 1.2, 95% CI 0.7-2.1, p=0.52). Although most patients received EN within 48 hours, there was no association between mNUTRIC score and timing of EN initiation after adjusting for demographic variables and illness severity.</div></div><div><h3>Conclusions</h3><div>Our findings indicate that while the mNUTRIC score can effectively identify malnutrition risk, it does not meaningfully inform early EN initiation timing nor predict mortality in mechanically ventilated trauma patients.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100080"},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons Learned From the Liver About the Undergraduate to Graduate Medical Education Transition","authors":"Alexander Y. Pan ,&nbsp;Pedram J. Khorsandi ,&nbsp;Jeanne M. Farnan ,&nbsp;Margarita N. German ,&nbsp;Pranab M. Barman ,&nbsp;Madeline A. Berschback ,&nbsp;Michael Kriss ,&nbsp;Ross McMillan ,&nbsp;Omar Mousa ,&nbsp;Frederick B. Peng ,&nbsp;Tejinder Randhawa ,&nbsp;Kamilah Scales ,&nbsp;Adam E. Mikolajczyk","doi":"10.1016/j.ajmo.2024.100079","DOIUrl":"10.1016/j.ajmo.2024.100079","url":null,"abstract":"<div><div>The burden of cirrhosis and chronic liver disease is growing, yet there is a projected worsening deficit in hepatology providers. As such, cirrhosis and liver disease have been important inclusions within the core curricula of Internal Medicine. Formal assessments of provider preparedness resulting from the curriculum are lacking though. Prior studies have demonstrated that exposure to cirrhosis in undergraduate medical education is insufficient, as are learner comfort and self-reported knowledge levels. These findings are further corroborated by a multicenter survey of incoming Internal Medicine interns showing that subjective comfort with and objective knowledge of various liver disease topics are lacking compared to other common Internal Medicine topics. This paper also demonstrates how similar surveys may be used to identify additional topics that may require adjustments for curricular improvement.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"13 ","pages":"Article 100079"},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postacute Sequelae of COVID-19 in Pediatric Patients Within the United States: A Scoping Review","authors":"Christine M. Miller ,&nbsp;Carla Borre ,&nbsp;Alex Green ,&nbsp;Melissa Funaro ,&nbsp;Carlos R Oliveira ,&nbsp;Akiko Iwasaki","doi":"10.1016/j.ajmo.2024.100078","DOIUrl":"10.1016/j.ajmo.2024.100078","url":null,"abstract":"<div><div>A subset of children and adolescents experience recurrent or persistent symptoms following SARS-CoV-2 infection, known as postacute sequelae of COVID-19 (PASC), however, the clinical epidemiology within the United States (US) is not yet well understood. This scoping review aims to synthesize the clinical epidemiology of pediatric PASC in the US. A comprehensive literature search was conducted and databases were queried from inception until January 29, 2024. Studies including US children and adolescents &lt;21 years old were considered. From 1028 studies identified, 29 met the inclusion criteria. Prevalence of PASC ranged from less than 1%-27%. Risk factors included older age, female sex, asthma, obesity, and severe initial infection. Common symptoms were dyspnea, fatigue, headaches, and chest pain. A multidisciplinary approach for diagnosis and management was common across studies. Most studies had a high risk of bias and were limited by a lack of standardized definitions and short follow-up duration. This review establishes a foundation for understanding pediatric PASC and highlights the critical need for continued research to optimize prevention and treatment strategies.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"12 ","pages":"Article 100078"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coaching People with Cardiovascular Disease to Close Their “Treatment Gaps” Reduces Hospital Utilization, Saves Lives, and Delivers Net Cost Savings Over 10 Years","authors":"Joshua Byrnes ,&nbsp;Margarite J. Vale ,&nbsp;Clifford Afoakwah ,&nbsp;Pippa Grant ,&nbsp;Sharmani Barnard","doi":"10.1016/j.ajmo.2024.100075","DOIUrl":"10.1016/j.ajmo.2024.100075","url":null,"abstract":"<div><h3>Background</h3><div>Disease management programs are an essential tool in the fight against rising prevalence and costs associated with cardiovascular disease (CVD). However, there is a lack of evidence on the long-term impact of these programs on clinical outcomes, healthcare utilization, and cost. This study presents a long-term follow up of clinical, healthcare utilization and cost, and mortality consequences of The COACH Program, a 6-month telephone delivered CVD prevention program.</div></div><div><h3>Methods</h3><div>We conducted 10-year retrospective propensity score matched cohort study of potentially eligible participants comparing individuals that participated to those that did not receive the Program. Primary outcomes of interest were differences in mortality, private healthcare utilization and cost of private healthcare utilization sourced from private health insurance claims data.</div></div><div><h3>Results</h3><div>Of the 24,932 potentially eligible participants, 11,988 were invited to participate in The COACH Program between July 1, 2010, and December 31, 2020. The COACH Program participants (<em>n</em> = 2,271) were 1:1 matched with individuals who did not participate in the Program. Participation in The COACH Program was associated with a 34% reduction in the risk of mortality (HR: 0.66, 95% CI: 0.54, 0.79), an 8% reduction in the number of hospitalizations (IRR: 0.92, 95% CI: 0.85, 0.98), and an annual reduction in healthcare costs of $1,499 (95% CI: $1,909, $1,087). Results were robust to sensitivity analyses.</div></div><div><h3>Conclusions</h3><div>A structured 6-month telephone delivered coaching program focused on closing “treatment gaps” in people with a history of CVD saves lives and reduces hospital utilization, health care costs over 10-years follow-up.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"12 ","pages":"Article 100075"},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of Change in Cognition Before and After COVID-19 Infection in Essential Workers at Midlife","authors":"Zennur Sekendiz ,&nbsp;Olga Morozova ,&nbsp;Melissa A. Carr ,&nbsp;Ashley Fontana ,&nbsp;Nikhil Mehta ,&nbsp;Alina Ali ,&nbsp;Eugene Jiang ,&nbsp;Tesleem Babalola ,&nbsp;Sean A.P. Clouston ,&nbsp;Benjamin J. Luft","doi":"10.1016/j.ajmo.2024.100076","DOIUrl":"10.1016/j.ajmo.2024.100076","url":null,"abstract":"<div><h3>Background</h3><div>Research into COVID-19-related cognitive decline has focused on individuals who are cognitively impaired following hospitalization for COVID-19. Our objective was to determine whether cognitive decline emerged after the onset of COVID-19 and was more pronounced in patients with postacute sequelae of SARS-CoV-2 infection (PASC).</div></div><div><h3>Methods</h3><div>We analyzed longitudinal cognitive data collected during a cohort study of essential workers at midlife that continued through the COVID-19 pandemic. We used longitudinal discontinuity models, a form of causal modeling, to examine the change in cognitive performance among 276 participants with COVID-19 in comparison to contemporaneously-collected information from 217 participants who did not have COVID-19. Cognitive performance across four domains was measured before and after the pandemic. Eligible study participants were those with validated COVID-19 diagnoses who were observed before having a verified COVID-19 infection who survived their initial infection, and for whom post-COVID-19 information was also available.</div></div><div><h3>Results</h3><div>The mean age of the COVID-19 group was 56.0 ± 6.6 years old, while the control group was 58.1 ± 7.3 years old. Longitudinal models indicated a significant decline in cognitive throughput (β = -0.168, P = .001) following COVID-19, after adjustment for pre-COVID-19 functioning, demographics, and medical factors. Associations were larger in those with more severe COVID-19 and those who reported PASC. Observed changes in throughput were equivalent to 10.6 years of normal aging.</div></div><div><h3>Conclusion</h3><div>Findings from this longitudinal causal modeling study revealed that COVID-19 and PASC appeared to cause clincially relevant cognitive deterioration.</div></div>","PeriodicalId":72168,"journal":{"name":"American journal of medicine open","volume":"12 ","pages":"Article 100076"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}