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Publisher: Elsevier   (Total: 3160 journals)

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Showing 1 - 200 of 3160 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 9)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 34, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 23, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 96, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 27, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 38, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 412, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 10, SJR: 0.18, CiteScore: 1)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.128, CiteScore: 0)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 259, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 28, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 14, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 17, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 8, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 10, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 154, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 14, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 33, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 14)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 9)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 24)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 28, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 46, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 58, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 16, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 8, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 23, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 22)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 35, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 7, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 18, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 17, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 12)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 64)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 399, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 11, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 34, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 345, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 455, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 17, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 41, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 3)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 57, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 10)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 51, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 54, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 45, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 34, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 28, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 35, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 47)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 215, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 28, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 38, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 62, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 17, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 42, SJR: 1.512, CiteScore: 5)
Analytical Biochemistry     Hybrid Journal   (Followers: 181, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 12, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 201, SJR: 1.58, CiteScore: 3)

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Journal Cover
American Journal of Medicine
Number of Followers: 47  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9343 - ISSN (Online) 1555-7162
Published by Elsevier Homepage  [3160 journals]
  • So, You Have to Give a Lecture—Are You Anxious'
    • Abstract: Publication date: Available online 5 December 2018Source: The American Journal of MedicineAuthor(s): Joseph S. Alpert
       
  • HYPONATREMIA: AN UNUSUAL LINK TO A COMMON ENCOUNTER
    • Abstract: Publication date: Available online 4 December 2018Source: The American Journal of MedicineAuthor(s): Raymond KH GOH, Brenda CHIANG, Marvin JW CHUA, Chaw Su NAING
       
  • Peri-Procedural Antithrombotic Management from a Patient Perspective: A
           Qualitative Analysis
    • Abstract: Publication date: Available online 3 December 2018Source: The American Journal of MedicineAuthor(s): Jennifer Acosta, Christopher Graves, Elizabeth Spranger, Jacob Kurlander, Anne E. Sales, Geoffrey D Barnes BackgroundPeri-procedural antithrombotic medication management is a complex, often confusing process for patients and their providers. Communication difficulties often lead to suboptimal medication management resulting in delayed or cancelled procedures.MethodsWe conducted telephone surveys with patients taking chronic antithrombotic medications who had recently undergone an endoscopy procedure. In the survey, we sought to better understand the peri-procedural process for patients taking antithrombotic medications. We conducted a content analysis of patients’ unstructured responses from the peri-procedural patient phone calls. We used a multi-step group coding process to analyze responses. Relationships between different themes and categories were analyzed using original quotes and retrieving thematic segments from the transcripts.ResultsThe survey was administered to 81 patients. 74/81 (91%) of respondents said they understood the plan to manage their antithrombotic, but 21/81 (26%) of respondents were not completely satisfied with the coordination, communication, and management of their medications. Five primary themes emerged from the content analysis as patient-centered design features affecting peri-procedural care: (1) patients require accurate and timely information; (2) a patient's prior experience with antithrombotic therapy affects their understanding of the process; (3) patients prefer receiving their information from a single source, and also prefer (4) different methods of instruction; (5) finally, patients expect their clinician(s) to be available through the peri-procedural management process.ConclusionTo optimize the peri-procedural medication management communication process, patients desire timeliness, accuracy, and adaptiveness to prior patient experience while offering a single, consistently available point of contact.
       
  • Colon Adenocarcinoma Presenting as Plummer-Vinson Syndrome
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Nellowe Candelario, Andrew Tiu
       
  • The Sunshine Act Has Been for a World that Doesn't Exist Anymore!
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Alain Braillon
       
  • Role of High-Dose Beta-Blockers in Patients with Heart Failure with
           Preserved Ejection Fraction and Elevated Heart Rate
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Phillip H. Lam, Neha Gupta, Daniel J. Dooley, Steven Singh, Prakash Deedwania, Michael R. Zile, Deepak L. Bhatt, Charity J. Morgan, Bertram Pitt, Gregg C. Fonarow, Ali Ahmed BackgroundBeta-blockers in high target doses are recommended for heart failure with reduced ejection fraction (HFrEF) but not for preserved ejection fraction (HFpEF). Treatment benefits are often more pronounced in high-risk subgroups, and patients with HFpEF with heart rate ≥70 beats per minute have emerged as such a high-risk subgroup. We examined the associations of high-dose beta-blocker use with outcomes in these patients.MethodsOf the 8462 hospitalized patients with heart failure with ejection fraction ≥50% in the Medicare-linked Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry, 5422 had a discharge heart rate ≥70 beats per minute. Of these, 4537 had no contraindications to beta-blocker use, of which 2797 (2592 with dose data) received prescriptions for beta-blockers. Of the 2592, 730 received high-dose beta-blockers, defined as atenolol ≥100 mg/day, carvedilol ≥50 mg/day, metoprolol tartrate or succinate ≥200 mg/day, or bisoprolol ≥10 mg/day, and 1740 received no beta-blockers. Using propensity scores for the receipt of high-dose beta-blockers, we assembled a matched cohort of 1280 patients, balanced on 58 characteristics.ResultsAll-cause mortality occurred in 63% and 68% of matched patients receiving high-dose beta-blocker vs no beta-blocker, respectively, during 6 years (median, 2.8) of follow-up (hazard ratio, 0.86; 95% confidence interval, 0.75-0.98; P = .027). The hazard ratios (95% confidence intervals) for all-cause readmission and the combined endpoint of all-cause readmission or all-cause mortality associated with high-dose beta-blocker use were 0.90 (0.81-1.02) and 0.89 (0.80-1.00), respectively.ConclusionsIn patients with HFpEF and heart rate ≥70 beats per minute, high-dose beta-blocker use was associated with a significantly lower risk of death. Future randomized controlled trials are needed to examine this association.
       
  • Corrigendum to Multiple Sclerosis Re-Examined: Essential and Emerging
           Clinical Concepts
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Jonathan Zurawski, James Stankiewicz
       
  • After the Match: Cultivating a Community of Support, Retention, and
           Mentoring to Enhance Diversity
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Cristin Colford, M. Suzanne Kraemer, Michael Contarino, Nancy Denizard-Thompson, Kimberley Evans, Kristen Hairston, Rachel Harris, Diana McNeill
       
  • Treatment of Syphilis-Associated Cerebral Vasculitis: Reappearance of an
           Old Question
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Arthur Mageau, Christine Rodriguez-Régent, Jérémie Dion, Nicolas Dupin, Luc Mouthon, Claire Le Jeunne, Alexis Régent BackgroundCerebral vasculitis caused by neurosyphilis is a re-emerging problem with diagnostic and treatment issues, especially for human immunodeficiency virus patients.MethodsWe present a case of relapsing syphilis-associated cerebral vasculitis, despite the recommended first-line antibiotic treatment, that was successfully treated with a second intravenous penicillin G course and corticosteroids.ResultsA 50-year old man went to the emergency department for bilateral episodes of red and painful eyes with progressive but severe visual acuity loss. He was diagnosed with bilateral panuveitis and neurosyphilis favored by an unknown human immunodeficiency virus infection with a CD4 count of 236 mm3. Despite appropriate and well-conducted treatment including intravenous penicillin G, short-term corticosteroid, and highly active antiretroviral therapy, a symptomatic relapse of the syphilis-associated cerebral vasculitis occurred. After a second course of penicillin and corticosteroids, he made a complete recovery.ConclusionsNeurosyphilis and human immunodeficiency virus co-infection is a reappearing challenging situation that should be considered with care by physicians because recommended antibiotic treatment sometimes fails. Corticosteroid therapy should be discussed in case of cerebral vasculitis.
       
  • The Reply
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Anthony J. Kanelidis, Drew Oehler, Jonathan D. Paul
       
  • Physical Diagnosis of Cardiac Tamponade
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Yasuharu Tokuda
       
  • Intracardiac Metastasis as the Initial Presentation ofNon–Small Cell
           Lung Cancer
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Carmel Moazez, Emily Howard, Azar Mehdizadeh, Raina Roy, Surabhi Amar
       
  • Febrile Calcinosis in Scleroderma
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Allan C. Gelber, Michael I. Brener, Kaelin O'Connell, Michael Wu, Julie J. Paik, Jemima F. Albayda
       
  • Serotonin Syndrome Masquerading as Ventricular Tachycardia Storm
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Ramzi Dudum, M. Imran Aslam, Jose Madrazo
       
  • An Oscillating Thrombus Inside the Inferior Vena Cava
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Christos Tourmousoglou, Gerasimos Gogas, Dimitrios Siskos, Dimitrios Zioutas
       
  • Progressive Dysphonia: Ortner Syndrome
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Matteo Coen, Igor Leuchter, Massimo Sussetto, Carlo Banfi, Raphaël Giraud, Karim Bendjelid
       
  • Swollen Extraocular Muscle and Tingling Extremities
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Futoshi Nakagami, Hideharu Hagiya, Akane Oyama, Kazuhiro Hongyo, Motonori Nagasawa, Hiromi Rakugi
       
  • Illusion, Suspicion, and Obstruction: An Intriguing Case of Acute Kidney
           Injury
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Abhilash Koratala, Gajapathiraju Chamarthi, Justin Lee Loy, Olanrewaju A Olaoye
       
  • Vitamin D Status and Exercise Capacity in Older Patients with Heart
           Failure with Preserved Ejection Fraction
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Ambarish Pandey, Dalane W. Kitzman, Denise K. Houston, Haiying Chen, M. Kyla Shea Background: Older patients with heart failure with preserved ejection fraction have severe exercise intolerance. Vitamin D may play a role in cardiovascular and skeletal muscle function, and may therefore be implicated in exercise intolerance in heart failure with preserved ejection fraction. However, there are few data on vitamin D status and its relationship to exercise capacity in heart failure with preserved ejection fraction patients.Methods: Plasma 25-hydroxyvitamin D (25[OH]D) and exercise capacity (peak oxygen consumption, [VO2], 6-minute walk distance) were measured in 112 older heart failure with preserved ejection fraction patients (mean ± SD age = 70 ± 8 years) and 37 healthy age-matched controls. General linear models were used to compare 25(OH)D between heart failure with preserved ejection fraction patients and healthy controls, and to determine the cross-sectional association between 25(OH)D and exercise capacity. The association between 25(OH)D and left ventricular function was evaluated secondarily in heart failure with preserved ejection fraction patients.Results: 25(OH)D concentrations were significantly lower in heart failure with preserved ejection fraction vs healthy controls (11.4 ± 0.6 ng/mL vs 19.1 ± 2.1 ng/mL; P = .001, adjusted for age, race, sex, body mass index, season). More than 90% of heart failure with preserved ejection fraction patients had 25(OH)D insufficiency (
       
  • Ideal Cardiovascular Health Is Inversely Associated with Nonalcoholic
           Fatty Liver Disease: A Prospective Analysis
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Long Wang, Mian Li, Zhiyun Zhao, Min Xu, Jieli Lu, Tiange Wang, Yuhong Chen, Shuangyuan Wang, Meng Dai, Yanan Hou, Xueyan Wu, Lina Ma, Lin Li, Shanshan Liu, Weiqing Wang, Yu Xu, Yufang Bi, Guang Ning BackgroundCardiovascular health has been proven to be associated with major cardiometabolic diseases. However, little is known of associations between cardiovascular health and nonalcoholic fatty liver disease.MethodsThis study included 3424 adults aged ≥40 years who were free of nonalcoholic fatty liver disease at baseline from a community cohort followed for up to 5 years. Liver ultrasonography was conducted at baseline and at follow-up to diagnose incident nonalcoholic fatty liver disease. Six metrics including smoking, physical activity, body mass index, total cholesterol, blood pressure, and fasting glucose were used to define cardiovascular health status. Associations of individual cardiovascular health metrics, number of cardiovascular health metrics, and overall cardiovascular health status at baseline, as well as changes in cardiovascular health during follow-up with risks of developing nonalcoholic fatty liver disease, were examined.ResultsA total of 649 participants developed nonalcoholic fatty liver disease during follow-up. Risks of nonalcoholic fatty liver disease reduced in a dose–response manner in participants with 3-4 ideal cardiovascular health metrics (odds ratio 0.50; 95% confidence interval, 0.41-0.61) and in participants with 5-6 ideal metrics (odds ratio 0.34; 95% confidence interval 0.22-0.51) compared with participants with 0-2 ideal metrics. An overall ideal or intermediate cardiovascular health was associated with 37% reduction in developing nonalcoholic fatty liver disease compared with poor cardiovascular health. In addition, improving cardiovascular health during follow-up reduced the risk by 71% compared with deteriorating cardiovascular health. Furthermore, an overall ideal or intermediate cardiovascular health was significantly associated with a lower fibrosis score in nonalcoholic fatty liver disease patients compared with an overall poor cardiovascular health.ConclusionsIdeal cardiovascular health was inversely associated with risks of nonalcoholic fatty liver disease. Although treatment of nonalcoholic fatty liver disease and subsequent inflammation and fibrosis remains a challenge, cardiovascular health goals should be advocated for nonalcoholic fatty liver disease prevention.
       
  • Contemporary Management and Outcomes of Patients with Massive and
           Submassive Pulmonary Embolism
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Eric Secemsky, Yuchiao Chang, C. Charles Jain, Joshua A. Beckman, Jay Giri, Michael R. Jaff, Kenneth Rosenfield, Rachel Rosovsky, Christopher Kabrhel, Ido Weinberg BackgroundFew contemporary studies have assessed the management and outcomes of patients with massive and submassive pulmonary embolism. Given advances in therapy, we report contemporary practice patterns and event rates among these patients.MethodsWe analyzed a prospective database of patients with massive and submassive pulmonary embolism. We report clinical characteristics, therapies, and outcomes stratified by pulmonary embolism type. Treatment escalation beyond systemic anticoagulation was defined as advanced therapy. Cox proportional hazards regression was used to identify predictors of 90-day mortality.ResultsAmong 338 patients, 46 (13.6%) presented with massive and 292 (86.4%) with submassive pulmonary embolism. The average age was 63 ± 15 years, 49.9% were female, 32.0% had malignancy, and 21.9% had recent surgery. Massive pulmonary embolism patients received advanced therapy in 71.7% (30.4% systemic thrombolysis, 17.4% catheter-directed thrombolysis, 15.2% surgical embolectomy) and had greater 90-day mortality rates compared with submassive pulmonary embolism patients (41.3% vs 12.3%, respectively; P < .01). Most massive pulmonary embolism deaths (78.9%) occurred in-hospital, whereas mortality risk persisted after discharge for submassive pulmonary embolism. After multivariable adjustment, massive pulmonary embolism was associated with a 5.23-fold greater hazard of mortality (95% confidence interval, 2.70-10.13; P < .01). Advanced therapies among all pulmonary embolism patients were associated with a 61% reduction in mortality (95% confidence interval, 0.20-0.76; P < .01).ConclusionsAmong contemporary massive and submassive pulmonary embolism patients, mortality remains substantial. Advanced therapies were frequently utilized and independently associated with lower mortality. Further investigation is needed to determine how to improve outcomes among these high-risk patients, including the optimal use of advanced therapies.
       
  • Sleep Duration and Risk of Fatal Coronary Heart Disease, Sudden Cardiac
           Death, Cancer Death, and All-Cause Mortality
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Hassan Khan, Danesh Kella, Setor K. Kunutsor, Kai Savonen, Jari A. Laukkanen BackgroundSleep duration has been shown to be associated with all-cause mortality; however, its relationship with cause-specific fatal events remains uncertain. We examined the relationship between sleep duration and risk of fatal coronary heart disease, sudden cardiac death, cancer-related death, and all-cause mortality.MethodsSleep duration was self-reported at baseline examinations performed between March 20, 1984, and December 5, 1989, in 2361 men aged 42-61 years from the Kuopio Ischemic Heart Disease study. Of these, 1734 (73.4%) men were free from coronary heart disease and cancer at baseline.ResultsA total of 802 all-cause deaths, 202 fatal coronary heart disease events, 141 sudden cardiac events, and 229 cancer-related deaths were reported during a median follow-up of 25.9 (interquartile range, 20.6-28.2) years. Multivariable adjusted hazard ratios comparing the top quartile (>10 hours) of sleep duration vs the bottom quartile (
       
  • Weight Gain and Health Affliction Among Former National Football League
           Players
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Timothy W. Churchill, Supriya Krishnan, Marc Weisskopf, Brandon A. Yates, Frank E. Speizer, Jonathan H. Kim, Lee E. Nadler, Alvaro Pascual-Leone, Ross Zafonte, Aaron L. Baggish BackgroundProfessional American-style football players are among the largest athletes across contemporary sporting disciplines. Weight gain during football participation is common, but the health implications of this early-life weight gain remain incompletely understood. We sought to define weight trajectories of former professional American-style football athletes and to establish their relationship with 5 common health afflictions (cardiovascular disease, cardiometabolic disease, neurocognitive impairment, sleep apnea, and chronic pain).MethodsA health survey was distributed to former National Football League (NFL) players. Former players reported body weight at 4 time points (high school, college, professional, and time of survey response) as well as maximal retirement weight. Logistic regression was used to assess associations between weight gain during football participation and health affliction.ResultsIn this cohort of former NFL players (n = 3,506, age 53 ± 14 years), mean weight increase from high school to time of survey response was 40 ± 36 pounds, with the majority of weight gain occurring during periods of football participation (high-school-to-college and college-to-professional). The prevalence of health afflictions ranged from 9% (cardiovascular disease) to 28% (chronic pain). Weight gain during football participation was independently associated with risk of multiple later-life health afflictions in models adjusted for football exposure, lifestyle variables, and post-career weight gain.ConclusionsEarly-life weight gain among American-style football athletes is common and is associated with risk of adverse health profiles during later-life. These findings establish football-associated weight gain as a key predictor of post-career health and raise important questions about the central role of targeted weight gain in this population.
       
  • Effects of Coffee Intake on Incident Chronic Kidney Disease: A
           Community-Based Prospective Cohort Study
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Jong Hyun Jhee, Ki Heon Nam, Seong Yeong An, Min-Uk Cha, Misol Lee, Seohyun Park, Hyoungnae Kim, Hae-Ryong Yun, Youn Kyung Kee, Jung Tak Park, Tae-Ik Chang, Ea Wha Kang, Tae-Hyun Yoo, Shin-Wook Kang, Seung Hyeok HanABSTRACTBackgroundDrinking coffee can raise public health problems, but the association between coffee and kidney disease is unknown. We studied whether coffee intake can affect the development of chronic kidney disease in the general population.MethodsWe analyzed 8717 subjects with normal renal function recruited from the Korean Genome and Epidemiology Study (KoGES) cohort. Based on a food frequency questionnaire, coffee consumption was categorized into 5 groups: 0 per week,
       
  • The Meaning of Vermoulu in Henrik Ibsen's Ghosts
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Leonard J. Hoenig
       
  • Optimal Systolic Blood Pressure Target in Resistant and Non-Resistant
           Hypertension: A Pooled Analysis of Patient-Level Data from SPRINT and
           ACCORD
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Steven M. Smith, Matthew J. Gurka, David A. Calhoun, Yan Gong, Carl J. Pepine, Rhonda M. Cooper-DeHoff BackgroundPrior studies suggest benefits of blood pressure lowering on cardiovascular risk may be attenuated in patients with resistant hypertension compared with the general hypertensive population, but prospective data are lacking.MethodsWe assessed intensive (
       
  • A Hoarse Warning: Ortner Syndrome
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Meng Ying Sim, Yong Chean Lim, Stephen Ching-Tung So, Junwei Zhang, Desmond B. Teo
       
  • Fast, Broad, and Irregular: Wolff-Parkinson-White Syndrome
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Rakhee R. Makhija, Theodore Chow, Sandhya Venugopal, Ezra A. Amsterdam
       
  • Not All It's CrAged Up to Be: Disseminated Cryptococcosis
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Jessica Haraga, Melissa LeBlanc, Joseph Chiovaro
       
  • A Unifying Diagnosis: IgG4-Related Disease
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Rachel Broderick, Angeliki Kazeros, Ainat Beniaminovitz, Ladan Fazlollahi, Pauline Yi, David Brogno, Katherine G. Nickerson
       
  • Reducing Unnecessary Vitamin D Screening in an Academic Health System:
           What Works and When
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Christopher M. Petrilli, James Henderson, Jenna M. Keedy, Emily R. Dibble, Melissa Y. Wei, Julie K. Prussack, Grant Greenberg, Eve A. Kerr
       
  • Decision-Making with D-Dimer in the Diagnosis of Pulmonary Embolism
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Wezi Sendama, Kathryn M. Musgrave The measurement of D-dimer can provide useful information to aid in the diagnosis of patients with suspected venous thromboembolism. D-dimer measurement in conjunction with adequate estimation of pretest probability can facilitate the safe discharge of patients with suspected pulmonary embolism and limit unnecessary investigation or anticoagulation. We review clinical decision-making strategies in the diagnosis of pulmonary embolism and propose means to minimize diagnostic error that might arise from knowledge of the D-dimer result prior to clinical assessment.
       
  • Dizziness
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Gregory T. Whitman Dizziness is a common symptom encountered by all physicians. Dizziness and related symptoms are frequently linked to 1 or more of a list of contributors that includes benign paroxysmal positional vertigo, Ménière disease, migraine, acute peripheral vestibulopathy, cerebral ischemia, and anxiety disorders. Awareness of these common clinical patterns increases the likelihood of making a rapid, accurate diagnosis.
       
  • Modern Trends in Dental Medicine: An Update for Internists
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Giovanna Orsini, Pierfrancesco Pagella, Thimios A. Mitsiadis Traumatic injuries, genetic diseases, and external harmful agents such as bacteria and acids often compromise tooth integrity. There is an unmet medical need to develop alternative, innovative dental treatments that complement traditional restorative and surgery techniques. Stem cells have transformed the medical field in recent years. The combination of stem cells with bioactive scaffolds and nanostructured materials turns out to be increasingly beneficial in regenerative dental medicine. Stem cell–based regenerative approaches for the formation of dental tissues will significantly improve treatments and will have a major impact in dental practice. To date there is no established and reliable stem cell–based treatment translated into the dental clinics, however, the advances and improved technological knowledge are promising for successful dental therapies in the near future. Here, we review some of the contemporary challenges in dental medicine and describe the benefits and future possibilities of certain novel approaches in the emerging field of regenerative dentistry.
       
  • Nonanesthetic Effects of Ketamine: A Review Article
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Jabril Eldufani, Alireza Nekoui, Gilbert Blaise Ketamine is considered a dissociative anesthetic medication, and it is commonly administered by a parenteral route. It works mainly by blocking the N-methyl-D-aspartate receptor. It inhibits the voltage-gated Na and K channels and serotonin and dopamine reuptake; also, it affects specific receptors, such as α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid, kainate, and aminobutyric acid A receptors. Ketamine appears to have particular mechanisms that are potentially involved during analgesic induction, including enhancing of descending inhibition and antiinflammatory effects. More recently, it has been shown that ketamine has potential in clinical practice for the management of chronic pain, cognitive function, depression, acute brain injury, and disorders of the immune system.
       
  • Dementia and Atrial Fibrillation: Pathophysiological Mechanisms and
           Therapeutic Implications
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Romain Chopard, Gregory Piazza, Seth Alan Gale, Umberto Campia, Ida Ehlers Albertsen, Jisoo Kim, Samuel Z. Goldhaber Atrial fibrillation increases the risk of stroke by a factor of four- to fivefold, and dementia is a common consequence of stroke. However, atrial fibrillation has been associated with cognitive impairment and dementia, even in patients without prior overt stroke. Nonischemic mechanisms include cerebral hypoperfusion, vascular inflammation, brain atrophy, genetic factors, and shared risk factors such as age or hypertension. Critical appraisal of studies evaluating the association between atrial fibrillation and dementia in stroke-free patients reveals that several suffer from methodological issues, such as not including silent stroke or anticoagulation therapy in multivariate analyses. Some studies show a close relationship between atrial fibrillation and dementia due to silent stroke, in the absence of overt stroke. Evidence is accumulating that anticoagulation may be effective to decrease the risk of dementia in atrial fibrillation patients. Overall, the pathogenesis linking atrial fibrillation to dementia is likely multifactorial. Cerebral infarctions, including silent stroke, play a central role. These findings underscore the importance of stroke prevention measures in atrial fibrillation patients.
       
  • Medical Principles in Obstetrical Consults
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Jonathan S. Zipursky, Donald A. Redelmeier
       
  • When Guidelines Cause Hypertension
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Nicholas Wald, David Wald, Arthur L. Kellermann
       
  • Advanced Therapies for Massive Pulmonary Embolism
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): James E. Dalen
       
  • Reform in House Staff Working Hours and Clinical Supervision: A 30-Year
           Reflection Following the Release of the Bell Commission Report
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): William H. Frishman, Joseph S. Alpert
       
  • Sloppy, Greedy, or Overworked'
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Joseph S. Alpert
       
  • Altruism: A Story in Three Acts
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Dominick Tammaro, James Arrighi, Ross Hilliard, Elizabeth Toll
       
  • Malignant Pancreatic insulinoma with large hepatic metastasis
    • Abstract: Publication date: Available online 30 November 2018Source: The American Journal of MedicineAuthor(s): Tariq A. Gojwari, Mohd Ilyas, Musaib Ahmad Dar, Aadil Hussain Malik, Mir Junaid Ahmad Kazimi
       
  • Connecting the Dots – Acute Abdomen, ST Elevation and a
           Consolidating Lung Mass
    • Abstract: Publication date: Available online 30 November 2018Source: The American Journal of MedicineAuthor(s): Randol Kennedy, Percy Adonteng-Boateng
       
  • Reactive arthritis caused by Haemophilus parainfluenzae in a
           diabetic patient
    • Abstract: Publication date: Available online 30 November 2018Source: The American Journal of MedicineAuthor(s): Tomohiro Eguchi, Taro Horino, Eri Amano, Osamu Ichii, Yoshio Terada
       
  • High Sensitivity Cardiac Troponin I Levels in Normal Pregnancy And When
           Complicated By Hypertension
    • Abstract: Publication date: Available online 30 November 2018Source: The American Journal of MedicineAuthor(s): J Ravichandran, SY Woon, YS Quek, YC Lim, EM Noor, K Suresh, R Vigneswaran, VC Vasile, AS Shah, NL Mills, J Sickan, A Beshiri, AS Jaffe ObjectiveTo examine the association of circulating concentrations of high-sensitivity cardiac troponin I (hs-Tn) in the various trimesters of pregnancy in patients with and without hypertension.MethodProspective cross-sectional study of pregnant and post-natal women aged between 18-35 years of age with no coexisting disease. Serum samples were analysed for hs-TnI.ResultsA total of 880 women (mean age 29.1 years [SD 5.1]) were recruited with 129 (14%), 207 (24%) and 416 (47%) patients in the first, second and third trimester. Ninety (10%) participants were recruited in the postnatal period. During pregnancy 28 (3%) patients were classified as having pregnancy induced hypertension and 10 (1%) as pre-eclampsia. High-sensitivity cardiac troponin I was measurable in 546 (62%) participants with a median of 1 ng/L (range 0 to 783 ng/L). Troponin concentrations were greater than 99th percentile in 19 (2%) individuals. Patients with pregnancy induced hypertension and pre-eclampsia had higher concentrations of hs-TnI (median 11 ng/L [IQR 6 to 22 ng/L] vs 12ng/L [IQR 3 to 98 ng/L] vs 1 ng/L [IQR 0 to 1 ng/L]). In logistic regression modelling hs-TnI concentration remained an independent predictor of pregnancy induced hypertension or pre-eclampsia in both unadjusted and adjusted models (OR 9.3 [95%CI 5.8 to 16.3] and 11.5 [95%CI 6.3 to 24.1] per doubling of hs-TnI concentrations).ConclusionCardiac troponin measured using a high-sensitivity assay is quantifiable in the majority of young pregnant women with 2% of individuals having concentration above the 99th centile sex specific threshold. Patients with pregnancy induced hypertension or pre-eclampsia had higher cardiac troponin concentrations. Cardiac troponin was a strong independent predictor of pregnancy induced hypertension or pre-eclampsia in pregnant and postnatal women.
       
  • Personality traits in patients with myocardial infarction with
           non-obstructive coronary arteries
    • Abstract: Publication date: Available online 30 November 2018Source: The American Journal of MedicineAuthor(s): Daniella Nero, Stefan Agewall, Maria Daniel, Kenneth Caidahl, Olov Collste, Christina Ekenbäck, Mats Frick, Loghman Henareh, Tomas Jernberg, Karin Malmqvist, Karin Schenck-Gustafsson, Jonas Spaak, Peder Sörensson, Örjan Sundin, Shams Y-Hassan, Claes Hofman-Bang, Per Tornvall ObjectiveTo describe type A behavior pattern and trait anger in patient with myocardial infarction with non-obstructive coronary arteries (MINOCA) and compare them to patient with coronary heart disease and healthy controls. Type A behavior pattern and anger have been linked to coronary heart disease in previous studies. This is the first study to assess type A behavior pattern and trait anger in MINOCA patients.MethodsOne-hundred MINOCA patients, consecutively recruited during 2007-2011 at five coronary care units in Stockholm, were matched for sex and age to 100 coronary heart disease patients and 100 healthy controls. All participants completed the Bortner rating scale to quantify type A behavior pattern and the Spielberger trait anger scale to quantify anger three months after the acute event.ResultsMINOCA patients Bortner rating scale score was 70.9±10.8 (mean±SD) and Spielberger trait anger scale score 14 (12-17) (median; IQR). Coronary heart disease patients Bortner rating scale score was 70.5±10.2 and Spielberger trait anger scale score 14 (12-17). Healthy controls Bortner rating scale score was 71.9±9.1 and Spielberger trait anger scale score 13 (11-16).ConclusionWe found no significant differences in Bortner rating scale score and Spielberger trait anger scale score between MINOCA, coronary heart disease patients and healthy controls, regardless of whether total scores, sub-scales or cut-offs were used to classify type A behavior pattern and trait anger. However, we cannot exclude existence of an occasional episode of anger or mental stress in relation to the coronary event. This is the first study to assess type A behavior pattern and trait anger in patients with MINOCA and future studies need to confirm the current findings before any firm conclusions can be made.
       
  • Strawberry marks on lip
    • Abstract: Publication date: Available online 30 November 2018Source: The American Journal of MedicineAuthor(s): Dr. Sowmya Sham Kanneppady, Dr. Sham Kishor Kanneppady, Dr. Tanay Chaubal, Dr. Ranjeet Bapat, Dr. Rohit Pandurangappa, Dr. Aung Myo Oo, Ohn Mar Lwin
       
  • Parental Leave in Graduate Medical Education: Recommendations for Reform
    • Abstract: Publication date: Available online 30 November 2018Source: The American Journal of MedicineAuthor(s): Patricia Vassallo, Jennifer Jeremiah, Leanne Forman, Lauralee Dubois, Debra Simmons, Katherine Chretien, Alpesh Amin, David Coleman, Frances Collichio
       
  • Bites that Spur the Blues: Maculae Ceruleae
    • Abstract: Publication date: Available online 30 November 2018Source: The American Journal of MedicineAuthor(s): Cuong V. Nguyen, Jaime L. Kingsley-Loso
       
  • Polypoidal trachea- A clinician's predicament
    • Abstract: Publication date: Available online 30 November 2018Source: The American Journal of MedicineAuthor(s): Pirabu Sakthivel, Kapil Sikka, Aanchal Kakkar, Sasikrishna Kavutharapu, Alok Thakar
       
  • A Moving Anecdote: Exercise-Induced Vasovagal Sinus Arrest
    • Abstract: Publication date: Available online 30 November 2018Source: The American Journal of MedicineAuthor(s): Mohammed Aliwaiai, Patsy P. Caceres-Figueroa, Freddy Del-Carpio Munoz
       
  • A Pharmacist-Led Intervention to Improve Gout Medication Adherence and
           Outcomes with Urate Lowering Therapy: A Site Randomized Trial
    • Abstract: Publication date: Available online 29 November 2018Source: The American Journal of MedicineAuthor(s): Ted R. Mikuls, T. Craig Cheetham, Gerald D. Levy, Nazia Rashid, Artak Kerimian, Kimberly J. Low, Brian W. Coburn, David T. Redden, Kenneth G. Saag, P. Jeffrey Foster, Lang Chen PurposeTo test a pharmacist-led intervention to improve gout treatment adherence and outcomes.MethodsWe conducted a site-randomized trial (n=1,463 patients) comparing a one-year, pharmacist-led intervention to usual care in gout patients initiating allopurinol. The intervention was delivered primarily through automated telephone technology. Co-primary outcomes were the proportion of patients adherent (proportion of days covered ≥0.8) and achieving a serum urate
       
  • Serum insulin and cognitive performance in older adults: a longitudinal
           study
    • Abstract: Publication date: Available online 29 November 2018Source: The American Journal of MedicineAuthor(s): Babak Hooshmand, Minna Rusanen, Tiia Ngandu, Jaana Leiviskä, Shireen Sindi, Christine A.F. von Arnim, Peter Falkai, Hilkka Soininen, Jaakko Tuomilehto, Miia Kivipelto ObjectiveTo examine the association of serum glucose, insulin, and insulin resistance with cognitive functioning seven years later in a longitudinal population-based study of Finnish older adults.MethodsSerum glucose and insulin were measured at baseline in 269 dementia-free individuals aged 65-79 years derived from the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study. Insulin resistance was estimated with the homeostasis model assessment (HOMA). Participants were re-examined seven years later, and global cognition, episodic memory, executive functioning, verbal expression, and psychomotor speed were assessed both at baseline and at follow-up. Multiple linear regression was used to investigate the associations with cognitive performance at follow-up, after adjusting for several potential confounders, including common vascular risk factors.ResultsIn the multivariable-adjusted linear regression models, no associations of insulin resistance with cognitive functioning were observed. After excluding 19 incident dementia cases, higher baseline HOMA values were related to worse performance in global cognition (β (standard error (SE)): -0.050 (0.02); P = 0.043) and psychomotor speed (β (SE): -0.064 (0.03); P = 0.043) seven years later. Raised serum insulin levels were associated with lower scores on global cognition (β (SE): -0.054 (0.03); P = 0.045) and tended to relate to poorer performance in psychomotor speed (β (SE): -0.061 (0.03); P = 0.070).ConclusionsSerum insulin and insulin resistance may be independent predictors of cognitive performance seven years later in elderly individuals without dementia. Randomized controlled trials are needed to determine this issue.
       
  • In a Critical State: Ongoing Barriers to Treatment for Hepatitis C Virus
           (HCV)
    • Abstract: Publication date: Available online 24 November 2018Source: The American Journal of MedicineAuthor(s): Jorge Mera, Brigg Reilley, Jessica Leston, David Stephens
       
  • Medicine as a Meritocracy
    • Abstract: Publication date: Available online 23 November 2018Source: The American Journal of MedicineAuthor(s): William H. Frishman, Joseph S. Alpert
       
  • Diabetes Care for Patients Experiencing Homelessness: Beyond Metformin and
           Sulfonylureas
    • Abstract: Publication date: Available online 23 November 2018Source: The American Journal of MedicineAuthor(s): Lauren K. Brooks, Nilesh Kalyanaraman, Rana Malek On any given night in the United States, an estimated 553,742 people are homeless. Applying a broader definition of homelessness that includes unstably housed people, an estimated 1.5% of Americans experience homelessness in a given year. Rates of diabetes are increasing amongst individuals experiencing homelessness. The social, psychological, and physical challenges of homelessness not only contribute to the rate of diabetes, but also complicate management. Unstable housing, limited medical resources, food insecurity, and competing priorities are barriers to diabetes care among patients experiencing homelessness. Homeless patients with diabetes more frequently develop specific comorbidities that require special attention, such as cardiovascular disease, substance abuse, depression, and foot wounds. The Affordable Care Act gave states the option to expand Medicaid to those earning up to 138% of the federal poverty level. This addressed a gap in coverage for low-income individuals not eligible for Medicaid or employer sponsored insurance. With increased insurance coverage, this has increased the variety of medications available to treat hyperglycemia from type 2 diabetes beyond metformin, sulfonylureas, and insulin. Several of the newer classes of medications have advantages for patients experiencing homelessness but also have special considerations in this vulnerable patient population. This narrative review will provide a review of dipeptidyl peptidase-4 inhibitor (DPP-4) inhibitors, glucagon-like peptide (GLP)-agonists, sodium glucose cotransporter (SGLT)-2 inhibitors, and thiazolidinediones (TZDs) in individuals experiencing homelessness.
       
  • Smoking and Solid Organ Transplantation: A review article highlighting the
           effects of smoking on solid organ transplantation outcomes
    • Abstract: Publication date: Available online 17 November 2018Source: The American Journal of MedicineAuthor(s): Karim H. Anis, Larry A. Weinrauch, John A. D'Elia Tobacco smoking is the leading preventable cause of death worldwide. Both donor and recipient smoking have been shown to increase graft loss and mortality in solid organ transplant recipients in many studies. Only in lung transplants is smoking a universal contraindication to transplantation. Transplant centers implement different policies regarding smoking recipients and allografts from smoking donors. Due to scarcity of available allografts the risks of smoking have to be weighed against the risks of a longer transplant wait list period. Although transplant centers implement different strategies to encourage smoking cessation pre and post-transplant, not many studies have been published that validate the efficacy of smoking cessation interventions in this vulnerable population. This article summarizes the results of studies investigating the prevalence, impact on outcomes and cessation interventions of smoking in the transplant population.We report herein a review of the elevated risks of infection, malignancy, graft loss, cardiovascular events and mortality in solid organ transplant populations.
       
  • The Rise of Documentation and the Destruction of Modern Medicine
    • Abstract: Publication date: Available online 16 November 2018Source: The American Journal of MedicineAuthor(s): Muhammad Shahzeb Khan, Haris Riaz
       
  • Typically Atypical: Merkel Cell Carcinoma
    • Abstract: Publication date: Available online 15 November 2018Source: The American Journal of MedicineAuthor(s): Andrew J. Krispinsky, Susan Massick
       
  • DAYS SPENT AT HOME IN THE LAST SIX MONTHS OF LIFE AMONG COMMUNITY-LIVING
           OLDER PERSONS
    • Abstract: Publication date: Available online 14 November 2018Source: The American Journal of MedicineAuthor(s): Thomas M. Gill, Evelyne A. Gahbauer, Linda Leo-Summers, Terrence E. Murphy, Ling Han BackgroundDays spent at home has recently been identified as an important patient-centered outcome; yet, relatively little is known about time spent at home at the end of life among community-living older persons.MethodsThe analytic sample included 457 decedents from an ongoing cohort study of 754 community-living persons, aged ≥ 70 years. Days spent at home were calculated as 180 days minus the number of days in a hospital, nursing home or hospice facility. The condition leading to death was determined from death certificates and comprehensive assessments.ResultsThe median number of days at home was 159 (interquartile range, 125–174). 138 (30.2%) decedents were at home during the entire 6-month period, while 163 (35.7%) were at home for fewer than 150 days. Days at home did not differ significantly by age (P=.922), sex (P=.238), or race/ethnicity (P=.199), but did differ according to the condition leading to death (P=.001), with the lowest value observed for organ failure (150 [106.5–168.5]), highest values for sudden death (177 [172–179]) and cancer (167 [140–174]), and intermedicate values for advanced dementia (164 [118–174]), frailty (160.5 [130–174]), and other conditions (153 [118–175]).ConclusionsAmong community-living older persons, days spent at home in the last six months of life do not differ by age, sex, or race/ethnicity, but are significantly lower for persons dying from organ failure. Additional efforts may be warranted to optimize time spent at home at the end of life, especially among older persons dying from organ failure.
       
  • CLINICAL CHARACTERISTICS AND ONE-YEAR OUTCOMES OF ELDERLY PATIENTS WITH
           ST-ELEVATION OR NON-ST-ELEVATION ACUTE CORONARY SYNDROME UNDERGOING
           PERCUTANEOUS CORONARY INTERVENTION
    • Abstract: Publication date: Available online 14 November 2018Source: The American Journal of MedicineAuthor(s): Nuccia Morici, Stefano Savonitto, Luca A Ferri, Daniele Grosseto, Irene Bossi, Paolo Sganzerla, Giovanni Tortorella, Michele Cacucci, Maurizio Ferrario, Gabriele Crimi, Ernesto Murena, Stefano Tondi, Anna Toso, Nicola Gandolfo, Amelia Ravera, Elena Corrada, Matteo Mariani, Leonardo Di Ascenzo, A. Sonia Petronio, Claudio CavalliniABSTRACTIntroductionAcute coronary syndromes have been classified according to the finding of ST-segment elevation on the presenting ECG, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome elderly patients undergoing percutaneous coronary intervention during index admission has not been published so far.MethodsRetrospective cohort study of patients enrolled in the Elderly-ACS 2 multicenter randomized trial. Main outcome measures were crude cumulative incidence and cause-specific hazard ratio (cHR) of cardiovascular death, non-cardiovascular death, reinfarction and stroke.ResultsOf 1443 ACS patients aged>75 years (median age 80, IQR 77-84), 41% were classified as ST Elevation Myocardial Infarction (STEMI), and 59% had Non-ST Elevation ACS (NSTEACS) (48% NSTEMI and 11% unstable angina). As compared to those with NSTEACS, STEMI patients had more favorable baseline risk factors, less prior cardiovascular events and less severe coronary disease, but lower ejection fraction (45% vs 50%, p
       
  • Nodular thyroid dermopathy: Not a hallmark of Graves’ disease
    • Abstract: Publication date: Available online 14 November 2018Source: The American Journal of MedicineAuthor(s): Mandeep Singla, Abhinav Gupta
       
  • Altitude Sickness Prevention with Ibuprofen Relative to Acetazolamide
    • Abstract: Publication date: Available online 10 November 2018Source: The American Journal of MedicineAuthor(s): Patrick Burns, Grant S. Lipman, Keiran Warner, Carrie Jurkiewicz, Caleb Phillips, Linda Sanders, Mario Soto, Peter Hackett BackgroundAcute mountain sickness is a common occurrence with travel to high altitude. Although previous studies of ibuprofen have shown efficacy for acute mountain sickness prevention, recommendations have been limited, as it has not been compared directly with acetazolamide, until this study.MethodsAdult volunteers were randomized to ibuprofen 600 mg, three times daily, 4 hours before ascent or acetazolamide 125 mg, twice daily, started the night before ascent to 3810m in the White Mountains of California. The main outcome measure was acute mountain sickness incidence, using the Lake Louise Questionnaire (LLQ), with a score of>3 with headache. Sleep quality and headache severity were measured with the Groningen Sleep Quality Survey (GSQS) and a modified visual analogue scale (mVAS).ResultsNinety-two participants completed the study: 45 (49%) ibuprofen and 47 (51%) acetazolamide. The incidence of acute mountain sickness was 56.5%, with ibuprofen 11% greater than acetazolamide, surpassing the predetermined 26% noninferiority margin (62.2% vs. 51.1%, 95% CI: - 11.1% to 33.5%). No difference was found in the total LLQ scores or subgroup symptoms between drugs (p=0.8). The GSQS correlated with LLQ sleep (r=0.77, 95% CI: 0.67 to 0.84) as was the mVAS with total LLQ severity (r = 0.57, 95% CI: 0.42 to 0.7). The acetazolamide group had higher SpO2 than ibuprofen (88.5% vs. 85.6%, p=0.001).ConclusionIbuprofen was slightly inferior to acetazolamide for acute mountain sickness prevention and should not be recommended over acetazolamide for rapid ascent. Average symptoms and severity were similar between drugs, suggesting prevention of disease.
       
  • Cannabis legalization does not influence patient compliance with opioid
           therapy
    • Abstract: Publication date: Available online 10 November 2018Source: The American Journal of MedicineAuthor(s): Sheng-Ying Lo, Gabrielle N. Winston-McPherson, Amy J. Starosta, Mark D. Sullivan, Geoffrey S. Baird, Andrew N. Hoofnagle, Dina N. Greene BackgroundPrescription opioid use and opioid related deaths continue to increase nationwide. Several states have adopted legislation allowing for recreational use of cannabis. Little is known about how recreational cannabis law impacts compliance in chronic pain patients prescribed opioid therapy. The goals of this study were to: 1) Retrospectively assess the effect of cannabis use on compliance with opioid therapy in a high-risk patient population and 2) Determine the impact that legalization of recreational cannabis had on patients prescribed therapeutic opioids.MethodsWe conducted a retrospective cohort study on results from a “high-risk” urine drug testing panel. Results from one year before and one year after initiation of recreational cannabis legislation were analyzed. This testing panel included qualitative assays for cannabinoids and nine other common drugs of abuse, in addition to a quantitative LC-MS/MS assay for 23 different opioids and metabolites. Opioid compliance was assigned by reviewing pathologist's interpretations.ResultsIn the pre-legalization period 1,776 panels were performed and post-legalization, 1,648 panels were performed. An increase (6%) in the rate of positive cannabinoid results was observed after legalization of recreational cannabis, however the overall compliance rate was consistent.ConclusionsThis study suggests that legalization of recreational cannabis does not affect compliance rate in patients treated with opioid therapy for chronic pain.
       
  • Divisions, Departments, and the 2018 Red Sox Baseball Team: Qualities of
           Leadership that Lead to Success
    • Abstract: Publication date: Available online 10 November 2018Source: The American Journal of MedicineAuthor(s): Joseph S. Alpert
       
  • Risk Estimation in Type 2 Myocardial Infarction and Myocardial Injury: The
           TARRACO Risk Score
    • Abstract: Publication date: Available online 9 November 2018Source: The American Journal of MedicineAuthor(s): German Cediel, Yader Sandoval, Anne Sexter, Anna Carrasquer, Maribel González-del-Hoyo, Gil Bonet, Carme Boqué, Karen Schulz, Stephen W. Smith, Antoni Bayes-Genis, Fred S. Apple, Alfredo BardajiABSTRACTOBJECTIVEDespite adverse prognoses of type 2 myocardial infarction and myocardial injury, an effective, practical risk stratification method remains an unmet clinical need. We sought to develop an efficient clinical bedside tool for estimating the risk of major adverse cardiovascular events at 180 days for this patient population.METHODSThe derivation cohort included patients with type 2 myocardial infarction or myocardial injury admitted to a tertiary hospital between 2012 and 2013 (n=611). The primary outcome was a major adverse cardiovascular event (death, re-admission for heart failure or myocardial infarction). The score included clinical variables significantly associated with the outcome. External validation was conducted using the UTROPIA cohort (n=401).RESULTSThe TARRACO score included cardiac troponin (cTn) concentrations and five independent clinical predictors of adverse cardiovascular events: age, hypertension, absence of chest pain, dyspnea, and anemia. The score exhibited good discriminative accuracy (AUC=0.74; 95%CI, 0.70–0.79). Patients were classified into low-risk (score 0–6) and high-risk (score ≥7) categories. Major adverse cardiovascular events rates were five-times more likely in high-risk patients compared with those at low risk (78.9 vs. 15.4 events/100 patient-years, respectively; log rank P
       
  • Tramadol: Distinguishing the Pathophysiology of Serotonin Syndrome and
           Seizures
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Bruno Mégarbane, Camille Lagard, Lucie Chevillard
       
  • The Reply
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Mohammad Kian Salajegheh, Rose M Domingo-Horne
       
  • Importance of Aminotransferase Elevation in Detecting Myopathy
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Zaven Sargsyan
       
  • The Reply
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Mathieu Pasquier, Matthieu de Riedmatten, Peter Paal
       
  • About Autoresuscitation in Accidental Hypothermia
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Les Gordon, Hermann Brugger
       
  • The Reply
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): James E Dalen
       
  • RoPES, Strokes and Closures
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Adil S. Wani, Suhail Q. Allaqaband, M. Fuad Jan
       
  • The Reply
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Cian P. McCarthy, Matthew DeCamp, John W. McEvoy
       
  • Point-of-Care Ultrasound for the Assessment of Digital Clubbing
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Inka Toman, Peter Rye, Janeve Desy, Irene W.Y. Ma
       
  • A Dangerous Entrapment: Pelvic Aneurysms Causing Hydronephrosis
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Ami Schattner, Ina Dubin, Yair Glick
       
  • Utilization of Vasculoprotective Therapy for Peripheral Artery Disease: A
           Systematic Review and Meta-analysis
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Daniel G. Hackam, Manav V. Vyas IntroductionPractice guidelines recommend that patients with peripheral artery disease receive antiplatelets, statins, and angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). We sought to quantify the rates of prescribing these therapies in patients with peripheral artery disease in the literature.MethodsWe performed a systematic review and meta-analysis of treatment prescribing rates in observational studies containing peripheral artery disease patients published on or after the year 2000. We also assessed whether prescribing rates are increasing over time.ResultsA total of 86 studies were available for analysis. The aggregate sample size across all studies was 332,555. The pooled estimates for utilization of antiplatelets, statins, and ACE inhibitors or ARBs were 75% (95% confidence interval [CI], 71%-79%), 56% (95% CI, 52%-60%), and 53% (95% CI, 49%-58%), respectively. Statin use was directly related to publication year (+2.0% per year, P < .001), but this was not the case for antiplatelets (P = .68) or ACE inhibitors or ARBs (P = .066).ConclusionsAlthough some improvement in statin prescribing has occurred in recent years, major practice gaps exist in the treatment of peripheral artery disease. Effective measures to close these gaps should be implemented.
       
  • B Minus: Wernicke's Encephalopathy
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Christopher L. Robinson, Jayshil J. Patel
       
  • Conduction Dysfunction and Near Expunction: Giant Cell Myocarditis
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Conrad Gleber, Ayhan Yoruk, Luke Eastburg, Bruce I. Goldman, Scott J. Cameron
       
  • When Appearance Is Everything: Chylous Ascites
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Vipul Nayi, Yanhua Wang, Benjamin Galen
       
  • A Vanishing Entity: Rheumatoid Vasculitis
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Joel Horton, Anand Kumthekar
       
  • Menace Elbow: Disseminated Nocardiosis
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Rupak Datta, Erik Kramer, Harald Reinhart, Sheldon Campbell, Ellice Wong, Shaili Gupta
       
  • New Injectable Agents for the Treatment of Type 2 Diabetes Part
           2—Glucagon-Like Peptide-1 (GLP-1) Agonists
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Christa George, AhYoung Byun, Amanda Howard-Thompson The US Food and Drug Administration has recently approved several new glucagon-like peptide-1 (GLP-1) agonists alone and in combination with various insulin products. The second of 2 articles in a series, this review will describe the potential advantages and disadvantages of the GLP-1 agonist class of products.
       
  • Paget's Disease of Bone: Diagnosis and Treatment
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Igor Kravets Paget's disease of bone is a common bone disorder characterized by disorganized bone remodeling. The most likely etiology is a slow paramyxoviral infection in genetically susceptible individuals; however, the exact cause is unknown. Enhanced bone resorption due to an increased activity of osteoclasts recruits numerous osteoblasts to resorption sites, with large quantities of new bone matrix produced as a result. The accelerated bone resorption and formation are not as closely coupled as in a healthy bone; a disorganized bone tissue is formed. Many patients are asymptomatic; rising serum alkaline phosphatase or incidental finding of characteristic radiographic lesions are often the only diagnostic clues. Common clinical manifestations include bone pain, bowing of long bones, enlarged skull, and hearing loss. An elevated serum alkaline phosphatase level correlates with the disease activity. The diagnosis is confirmed by characteristic radiographic findings and by nuclear scintigraphy of the bone (the most sensitive test). Bisphosphonates, such as zoledronic acid, pamidronate, alendronate, and risedronate, are the mainstay of treatment. Patients who do not tolerate bisphosphonates can be treated with calcitonin.
       
  • Spinal Cord Disorders: Myelopathy
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Shamik Bhattacharyya Myelopathy is a clinical diagnosis based on symptoms and physical examination findings. Laboratories and imaging, particularly with magnetic resonance imaging, can suggest a cause. Compressive myelopathy from degenerative disease of the vertebral column is the most common cause of myelopathy in older adults and should be screened for first in most cases. There are many other causes of myelopathy, including infectious, immune-mediated, nutritional, vascular, and neoplastic etiologies.
       
  • Historical Milestones in the Management of Stable Coronary Artery Disease
           over the Last Half Century
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): William S. Weintraub, David P. Taggart, G. B. John Mancini, David L. Brown, William E. Boden Coronary revascularization for coronary artery disease dates back to the introduction of coronary bypass by Favaloro in 1967 and coronary angioplasty by Gruentzig in 1977 (first published in 1968 and 1978, respectively). There have been many technical improvements over the ensuing 5 decades, studied in clinical trials. This article reviews the history of coronary revascularization (the development of optimal medical therapy) and points the way to the future of stable coronary artery disease management.
       
  • The Limits of Cardiac Performance: Can Too Much Exercise Damage the
           Heart'
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Prashant Rao, Adolph M. Hutter, Aaron L. Baggish Routine moderate-intensity physical activity confers numerous cardiovascular benefits and reduces all-cause mortality. However, the health impact of exercise doses that exceed contemporary physical activity guidelines remains incompletely understood, and an emerging body of literature suggests that high levels of exercise may have the capacity to damage the cardiovascular system. This review focuses on the contemporary controversies regarding high-dose exercise and cardiovascular morbidity and mortality. We discuss the limitations of available studies, explore potential mechanisms that may mediate exercise-related cardiac injury, and highlight the gaps in knowledge for future research.
       
  • Hepatitis C Infection Screening and Management in Opioid Use Epidemics in
           the United States
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Xibei Liu, Jay Shen, Pearl Kim, Seong-min Park, Sungyoun Chun, Jen-Jung Pan, Mohamed Azab, Haneul Choi, Hyeyoung Yeom, Yong-Jae Lee, Ji Won Yoo
       
  • The Big Health Data–Intelligent Machine Paradox
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): D. Douglas Miller
       
  • Sherlock Holmes and the Case of the Vanishing Examination
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Sutchin R. Patel, Sara L. Best, Ronald Rabinowitz
       
  • Hospitalists, Medical Education, and U.S. Health Care Costs
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): James E. Dalen, Kenneth J. Ryan, Anna L. Waterbrook, Joseph S. Alpert
       
  • The Fourth Edition of the Universal Definition of Myocardial Infarction
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Joseph S. Alpert
       
  • Career-Focused Mentoring for Early-Career Clinician Educators in Academic
           General Internal Medicine
    • Abstract: Publication date: November 2018Source: The American Journal of Medicine, Volume 131, Issue 11Author(s): Jonathan D. Kirsch, Alisa Duran, Alexander M. Kaizer, Heather Thompson Buum, William N. Robiner, Anne Marie Weber-Main
       
 
 
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