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Publisher: Elsevier   (Total: 3184 journals)

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Showing 1 - 200 of 3184 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 37, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 100, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 40, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 6)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 436, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 28, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 309, 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: 2, 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: 25, 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: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 183, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 29, 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: 11, 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: 15, 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: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, 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: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, 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: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 12)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 43, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, 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: 51, 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: 65, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 10, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 7, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 24)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, 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: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, 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: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 12, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 8, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 24)
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: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, 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: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 18)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 9, 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: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
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: 66)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 1, 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: 421, 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: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 37, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 53, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 385, 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: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 474, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 45, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 7, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 11)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, 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: 10, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 54, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 63, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 46, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 12)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 37, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 36, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
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: 250, 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: 32, 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: 39, 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: 66, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 24, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
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: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 211, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, 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: 222, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 6, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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Similar Journals
Journal Cover
American Journal of Medicine
Number of Followers: 50  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9343 - ISSN (Online) 1555-7162
Published by Elsevier Homepage  [3184 journals]
  • Long-term courses of sepsis survivors: effects of a primary care
           management intervention
    • Abstract: Publication date: Available online 13 September 2019Source: The American Journal of MedicineAuthor(s): Konrad FR Schmidt, Daniel Schwarzkopf, Laura-Mae Baldwin, Frank M Brunkhorst, Antje Freytag, Christoph Heintze, Konrad Reinhart, Nico Schneider, Michael von Korff, Susanne Worrack, Michel Wensing, Jochen Gensichen, the SMOOTH Study GroupAbstractBackgroundSepsis survivors face mental and physical sequelae even years after discharge from the intensive care unit (ICU). The aim of this study was to evaluate the long-term courses of sepsis survivors and the effects of a primary care management intervention in sepsis aftercare.MethodsThis study presents a 24-month follow-up of a randomized controlled trial that recruited 291 patients who survived sepsis (including septic shock) from nine German ICUs. Participants were randomized to usual care (n = 143) or to a 12-month-intervention (n = 148). The intervention included training of patients and their primary care physicians (PCP) in evidence-based post-sepsis care, case management provided by trained nurses and clinical decision support for PCPs by consulting physicians. Usual care was provided by PCPs in the control group.At the 24-month follow-up, 12 months after the 1-year-intervention, survival and measures of mental and physical health were collected by telephone interviews.Results186 [63.9%, 98 intervention, 88 control] of 291 patients completed the 24-month follow-up showing both increased mortality and recovery from functional impairment. Unlike the intervention group, the control group showed a significant increase of posttraumatic stress symptoms according to the Posttraumatic Symptom Scale (PTSS-10) (diff. PTSS-10 to baseline, mean (SD) 3.7(11.8) control vs. -0.7(12.1) intervention; p = 0.016). There were no significant differences in all other outcomes between the intervention and control groups.Conclusions12 months after completion, a primary care management intervention among survivors of sepsis did not improve mental health-related quality of life. Patients in the intervention group showed less posttraumatic stress symptoms.
       
  • Functional decline in an elderly: Connecting the dots to reach the
           diagnosis
    • Abstract: Publication date: Available online 13 September 2019Source: The American Journal of MedicineAuthor(s): Chong Ya Yuan Nicole, Benjamin Yong-Qiang Tan MMED, Joy Vijayan
       
  • Necrobiosis Lipoidica
    • Abstract: Publication date: Available online 12 September 2019Source: The American Journal of MedicineAuthor(s): Lucien Marchand, Sylvie Villar-Fimbel
       
  • Clinical Practice Update on Infectious Endocarditis
    • Abstract: Publication date: Available online 12 September 2019Source: The American Journal of MedicineAuthor(s): Sami El-Dalati, Daniel Cronin, Michael Shea, Richard Weinberg, IV James Riddell, Laraine Washer, Emily Shuman, James Burke, Sadhana Murali, Christopher Fagan, Twisha Patel, Kirra Ressler, George Michael DeebAbstractInfectious endocarditis is a highly morbid disease with approximately 43,000 cases per year in the United States. The modified Duke Criteria have poor sensitivity, however advances in diagnostic imaging provide new tools for clinicians to make this at times elusive diagnosis. There are a number of risk stratification calculators which can help guide providers in medical and surgical management. Patients who inject drugs pose unique challenges for the health care system as their addiction, which is often untreated, can lead to recurrent infections after valve replacement. There is a need to increase access to medication assisted treatment for opioid use disorders in this population. Recent studies suggest that oral and depo antibiotics may be viable alternatives to conventional intravenous therapy. Additionally, shorter courses of antibiotic therapy are potentially equally efficacious in surgically managed patients. Given the complexities involved with their care, endocarditis patients are best managed by multidisciplinary teams.
       
  • Establishing and Maintaining Research Integrity at Academic Institutions:
           Challenges and Opportunities
    • Abstract: Publication date: Available online 12 September 2019Source: The American Journal of MedicineAuthor(s): Janet D. Robishaw, David L. DeMets, Sarah K. Wood, Phillip M. Boiselle, Charles H. HennekensAbstractIntegrity and trust are essential attributes of medical researchers. Research misconduct represents clear and present dangers to academic institutions and their faculty, residents, students, and staff.To achieve and maintain public trust, medical researchers must achieve and maintain research integrity. To do so requires synchronicity and collaboration between, as well as within all academic institutions. Substantial failures to maintain research integrity by institutional leadership will lead to increasing demands to do so from the funding organizations as well as the general public. This, in turn, will lead to avoidable consequences of substantial penalties, financial and otherwise, adverse publicity and reputational damage.Researchers must self-regulate to avoid pitfalls, including those created by changes in the medical care delivery system that have decreased the influence of health care providers and increased the influence of outside legal and business interests. Our common goal should be to return public trust in our research enterprise that has done so much good for so many, but requires the establishment and maintenance of vigilance to establish and maintain research integrity.
       
  • Newly diagnosed hemophilia in an older adult
    • Abstract: Publication date: Available online 11 September 2019Source: The American Journal of MedicineAuthor(s): Paul B. Cornia
       
  • Physician Stress and Burnout
    • Abstract: Publication date: Available online 11 September 2019Source: The American Journal of MedicineAuthor(s): Scott W YatesAbstractTens (or hundreds) of thousands of Americans die each year as a result of preventable medical errors. Changes in the practice and business of medicine have caused some to question whether burnout among physicians and other healthcare providers may adversely affect patient outcomes. A clear consensus supports the contention that burnout affects patients, albeit with low quality objective data. The psychological and physical impact on physicians and other providers is quite clear however, and the impact on the physician workforce (where large shortages are projected) is yet another cause for concern. We have all heard the airplane safety announcement remind us to “please put on your own oxygen mask first before assisting others.” But, like many airline passengers (very few of whom use oxygen masks correctly when they are needed), physicians often do not recognize symptoms of burnout or depression, and even less often do they seek help. We detail causes and consequences of physician burnout and propose solutions to increase physician work satisfaction.
       
  • Strategies of Unloading the Failing Heart from Metabolic Stress
    • Abstract: Publication date: Available online 11 September 2019Source: The American Journal of MedicineAuthor(s): Efstratios Koutroumpakis, Bartosz Jozwik, David Aguilar, Heinrich TaegtmeyerAbstractWe propose a unifying perspective of heart failure in patients with type 2 diabetes mellitus. The reasoning is as follows: cellular responses to fuel overload include dysregulated insulin signaling, impaired mitochondrial respiration, reactive oxygen species formation and the accumulation of certain metabolites, collectively termed glucolipotoxicity. As a consequence, cardiac function is impaired with intracellular calcium cycling and diastolic dysfunction as an early manifestation. In this setting, increasing glucose uptake by insulin or insulin sensitizing agents only worsens the disrupted fuel homeostasis of the heart. Conversely, restricting fuel supply by means of caloric restriction, surgical intervention, or certain pharmacologic agents will improve cardiac function by restoring metabolic homeostasis. The concept is borne out by clinical interventions, all of which unload the heart from metabolic stress.
       
  • Effectiveness of Inferior Vena Cava Filters in Patients with Stable and
           Unstable Pulmonary Embolism and Trends in Their Use
    • Abstract: Publication date: Available online 11 September 2019Source: The American Journal of MedicineAuthor(s): Paul D Stein, Fadi Matta, Mary J. HughesAbstractBackgroundTrends in the use of inferior vena cava (IVC) filters in patients with pulmonary embolism (PE) who are stratified according to whether they are stable or unstable (in shock or ventilator dependent) may show where improvements of management could be made according to the best evidence that we now have.MethodsThis was a retrospective cohort study based on administrative data, 1999–2014, from the National (Nationwide) Inpatient Sample.ResultsIn–hospital all–cause mortality in unstable patients who received an IVC filter was lower in each year of investigation and in all age groups. Mortality from 1999 to 2014 was 10,140 of 35,230 (28.8%) with an IVC filter compared with 54,018 of 116,642 (46.3%) without a filter (P 
       
  • Diagnostic Error & Anchoring Bias in a Patient with Schizophrenia
    • Abstract: Publication date: Available online 11 September 2019Source: The American Journal of MedicineAuthor(s): Shirin Hemmat, Lekshmi Santhosh
       
  • Spontaneous Resolution of Abdominal Pseudohernia following Herpes Zoster
    • Abstract: Publication date: Available online 11 September 2019Source: The American Journal of MedicineAuthor(s): Alexandria Riopelle, Daniel Kim, Amit Dayal
       
  • Epicardial Adipose Tissue Inflammation Can Cause the Distinctive Pattern
           of Cardiovascular Disorders Seen in Psoriasis
    • Abstract: Publication date: Available online 11 September 2019Source: The American Journal of MedicineAuthor(s): Milton PackerAbstractPsoriasis is a systemic inflammatory disorder that can target adipose tissue; the resulting adipocyte dysfunction is manifest clinically as the metabolic syndrome, which is present in ≈ 20–40% of patients. Epicardial adipose tissue inflammation is likely responsible for a distinctive pattern of cardiovascular disorders, consisting of1: accelerated coronary atherosclerosis leading to myocardial infarction,2 atrial myopathy leading to atrial fibrillation and thromboembolic stroke, and3 ventricular myopathy leading to heart failure with a preserved ejection fraction. If cardiovascular inflammation drives these risks, then treatments that focus on blood pressure, lipids and glucose will not ameliorate the burden of cardiovascular disease in patients with psoriasis, especially in those who are young and have severe inflammation. Instead, interventions that alleviate systemic and adipose tissue inflammation may not only minimize the risks of atrial fibrillation and heart failure, but may also have favorable effects on the severity of psoriasis. Viewed from this perspective, the known link between psoriasis and cardiovascular disease is not related to the influence of the individual diagnostic components of the metabolic syndrome.
       
  • What patients with Idiopathic Pulmonary Fibrosis and caregivers want –
           Filling the currents gaps with patient reported outcomes and experience
           measures
    • Abstract: Publication date: Available online 11 September 2019Source: The American Journal of MedicineAuthor(s): Meena Kalluri, Fabrizio Luppi, Giovanni FerraraAbstractIdiopathic pulmonary fibrosis is a progressive disease, with a high mortality within the first 3–5 years from diagnosis and a poor quality of life mainly because of the burden of symptoms, such as dyspnea and cough, occurring usually many months before the diagnosis. Although available antifibrotic therapies slow down disease progression, they have no impact on quality of life. Moreover, healthcare around idiopathic pulmonary fibrosis patients is very often “disease-centered”, and relies on clinical surrogate outcomes that are poorly related to patients' quality of life and disease experience.Therefore, patients with idiopathic pulmonary fibrosis have several unmet needs in all domains of health that they wish to see recognized and addressed in the context of the treatment of their disease and its complications.In this review, we summarize the care pathway from the patients' perspective, identifying current gaps in care, education, support and communication between patients with idiopathic pulmonary fibrosis, their caregivers and care teams during the patient journey. The role of patients reported outcomes (PROs), PRO measures (PROMs) and patient reported experience measures (PREMs) in their care is discussed, as well as the need of disease specific PROs/PROMs/PREMs.
       
  • Pulmonary Embolism a Potential Cause of Myocardial Infarction With
           Nonobstructive Coronary Arteries
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Oscar M.P. Jolobe
       
  • Comments on ‘Medicine as a Meritocracy’
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Tushar Garg
       
  • Shortening the Training Period of Primary Care Doctors
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Edward Volpintesta
       
  • The Effects of Dairy Consumption on Blood Pressure and Risk of
           Hypertension
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Massimo Leggio, Cristina Tiberti, Massimo Armeni, Giorgio Limongelli, Andrea Mazza
       
  • The Reply
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Firas El Chaer, Hana M. El Sahly
       
  • The Reply
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): James E. Dalen
       
  • Comments on More Sub-Subs Are Coming!
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Kyle Rowe, Whitney Rowe
       
  • The Reply
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): James M. Rippe
       
  • Healthy at 100 Through Lifestyle Medicine
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Qi Lin, Xue Qing Wu, M.J. Quinn
       
  • Catastrophic Antiphospholipid Syndrome as a Cause of Severe
           Gastrointestinal Bleeding
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Sae K. Jang, Andrea Sitek, Samar Said, Raymond C. Shields
       
  • Reactive Perforating Collagenosis in End-Stage Renal Disease: Not All that
           Itches Is Uremic Pruritis!
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Harini Bejjanki, Alan E. Siroy, Abhilash Koratala
       
  • A Disappearing Lung Mass: Round Pneumonia
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Sonali Gupta, Pradeep Goyal, Aleksandra Rosinski
       
  • Intestinal Spirochetosis Masquerading as Inflammatory Bowel Disease
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Aarshi Vipani, Michael X. Yang
       
  • Rhabdomyolysis and Acute Kidney Injury Associated with Anabolic Steroid
           Use
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Karthik Gnanapandithan, Nishrutha Karthik, Abhijai Singh
       
  • Almost Killed by Love: A Cautionary Coital Tale
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Mark C. Marchitto, Devin Petrone, Jeremy D. Gradon
       
  • Are E-Cigarettes the Answer' A Novel Case of Methemoglobinemia
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Patrick Twohig, Jaclyn Rivington, William Cook
       
  • Anticoagulation-Related Nephropathy: The Most Common Diagnosis You've
           Never Heard Of
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Thomas Oliver, Liann Abu Salman, Brandon Ciaudelli, David A. CohenAbstractAnticoagulation-related nephropathy might just be the most common diagnosis you've never heard of. It was formerly known as warfarin-induced nephropathy, until it was observed with numerous other anticoagulants and broadened to anticoagulation-related nephropathy. It is a potentially devastating disorder with serious and life-changing consequences if not recognized and diagnosed swiftly. As the clinician is faced with new acute renal failure, it is important to appreciate those factors that place patients at greater risk of anticoagulation-related nephropathy: conditions such as underlying chronic kidney disease patients and supratherapeutic international normalized ratio. Through greater understanding of this common yet under-recognized condition, we become better equipped to diagnose and prognosticate potential patients. Currently, there are no specific guidelines to follow regarding anticoagulation-related nephropathy identification and management; however, it is an entity that is important to remember, especially given the number of patients requiring anticoagulation for numerous conditions.
       
  • Left Ventricular Thrombus After Primary PCI for ST-Elevation Myocardial
           Infarction: 1-Year Clinical Outcomes
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Alastair J. Moss, Anoop S.V. Shah, Eunice T. Zuling, Michael Freeman, David E. Newby, Philip D. Adamson, Nicholas L. CrudenAbstractBackgroundLeft ventricular thrombus formation is a complication of acute myocardial infarction. However, the incidence and risk of systemic thromboembolism in the era of primary angioplasty for ST elevation myocardial infarction (STEMI) is unclear. This study aims to determine clinical outcomes in patients with STEMI treated with primary angioplasty and left ventricular thrombus at 1 year.MethodsPatients who underwent primary angioplasty for STEMI and had a transthoracic echocardiogram were recruited. The primary endpoint was a composite of all-cause mortality, stroke, and systemic thromboembolism at 1 year. For the primary endpoint, the difference between the presence and absence of left ventricular thrombus was compared using a logistic regression, adjusting for minimization variables including age, diabetes mellitus, hypertension, and previous stroke.ResultsOf 2608 patients who underwent primary angioplasty for STEMI, 1645 (63%) patients had a transthoracic echocardiogram performed during the index hospital admission. Forty patients (2.4%) had evidence of left ventricular thrombus on transthoracic echocardiography. Patients with left ventricular thrombus were more likely to develop atrial fibrillation in the immediate postinfarction period (6 [15%] vs 87 [5.4%], P = 0.025). At 1 year, the primary endpoint occurred in 4 (10%) patients with left ventricular thrombus and 146 (9.1%) who did not (logistic regression hazard ratio 0.79, 95% confidence interval 0.23-2.70).ConclusionsIn the contemporary era of mechanical reperfusion for STEMI, echocardiographic detection of left ventricular thrombus was observed in
       
  • Association of Thrombocytopenia, Revascularization, and In-Hospital
           Outcomes in Patients with Acute Myocardial Infarction
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Gregory D. Rubinfeld, Nathaniel R. Smilowitz, Jeffrey S. Berger, Jonathan D. NewmanAbstractBackgroundThe impact of thrombocytopenia on revascularization and outcomes in patients presenting with acute myocardial infarction remains poorly understood. We sought to evaluate associations between thrombocytopenia, in-hospital management, bleeding, and cardiovascular outcomes in patients hospitalized for acute myocardial infarction in the United States.MethodsPatients hospitalized from 2004 to 2014 with a primary diagnosis of acute myocardial infarction were identified from the National Inpatient Sample. Management of acute myocardial infarction was compared between patients with and without thrombocytopenia. Multivariable logistic regression models were used to estimate odds of in-hospital adverse events stratified by thrombocytopenia and adjusted for demographics, cardiovascular risk factors, comorbidities, and treatment.ResultsA total of 6,717,769 patients were hospitalized with a primary diagnosis of acute myocardial infarction, and thrombocytopenia was reported in 219,351 (3.3%). Patients with thrombocytopenia were older, more likely to have other medical comorbidities, were more likely to undergo coronary artery bypass grafting (28.8% vs 8.2%, P < .001), and were less likely to receive a drug-eluting stent (15.5% vs 29.5%, P < .001). After multivariable adjustment, thrombocytopenia was independently associated with nearly twofold increased odds of in-hospital mortality (adjusted odds ratio 1.91; 95% confidence interval, 1.86-1.97). Thrombocytopenia was also independently associated with ischemic stroke, cardiogenic shock, cardiac arrest, and bleeding complications.ConclusionsPatients with thrombocytopenia in the setting of acute myocardial infarction had increased odds of bleeding, cardiovascular outcomes, and mortality compared with patients without thrombocytopenia. Future investigations to mitigate the poor prognosis of patients with acute myocardial infarction and thrombocytopenia are warranted.
       
  • A Novel Technique to Expand the Electrocardiographic Recording Capability
           from an Apple Watch
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Daniel R. Frisch
       
  • Woman with Fatigue, Peripheral Neuropathy, Lower Extremity Edema, and
           Palpable Purpura: Type II Cryoglobulinemia
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Connie S. Zhong, Sherry H. Yu, Kristine M. Cornejo, Steven T. Chen
       
  • A Peculiar Case of Purpura
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Yael M. Szterenlicht, Amir Jarjoui, Ramzi Kurd, Ludmila Levy, Gabriel Munter
       
  • Beach Bummer: A Recurrent Pruritic Buttocks Eruption Following Travel
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Kristina Navrazhina, Brian P. Hibler, Cynthia M. Magro, Horatio F. Wildman
       
  • Update in Outpatient General Internal Medicine: Practice-Changing Evidence
           Published in 2018
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Majken T. Wingo, Jason H. Szostek, Karna K. Sundsted, Jason A. Post, Karen F. Mauck, Mark L. WielandThe expansive scope of general internal medicine makes it difficult to identify practice-changing medical literature. Clinical updates can be facilitated by synthesizing relevant articles and implications for practice. Six internal medicine physicians reviewed the titles and abstracts in the 7 general internal medicine clinical outpatient journals with the highest impact factor and relevance to the internal medicine outpatient physician: New England Journal of Medicine (NEJM), Lancet, Annals of Internal Medicine, Journal of the American Medical Association (JAMA), JAMA-Internal Medicine, British Medical Journal (BMJ), and Public Library of Science (PLoS) Medicine. The following collections of article synopses and databases were also reviewed: American College of Physicians Journal Club, NEJM Journal Watch, BMJ Evidence-Based medicine, McMaster/DynaMed Evidence Alerts, and Cochrane Reviews. A modified Delphi method was used to gain consensus on articles based on clinical relevance to outpatient Internal Medicine, potential impact on practice, and strength of evidence. Article qualities and importance were debated until consensus was reached. Clusters of articles pertinent to the same topic were considered together. In total, 7 practice-changing articles were included.
       
  • The Medical Profession, Industry, and Continuing Medical Education:
           Finding the Balance That's Right for Patients
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Peter Kearney, Maarten Simoons, Lars Ryden, Paulus Kirchhof, Axel Pries, Colm O'Morain, Jeroen J. BaxAbstractProvision and participation in formal external continuing medical education (CME) is costly. Employer or state support of CME is the exception rather than the rule. The medical industry has supported both providers and consumers of educational activities, leading to concerns of commercial bias. Recent medical industry initiatives in Europe to improve the transparency of the relationship between industry and the profession, including the field of medical education, have had the paradoxical effect of the industry playing an increasingly direct role in the provision of physician education. Funding of medical professional society annual congresses has been directly and indirectly jeopardized. Acknowledging that there are areas of cooperation in the field of education between the medical profession and the medical industry from which both can benefit, we argue that medical education requires an objective approach that the primary fiduciary duty of medical industry companies precludes. Medical professional societies, as not-for-profit organizations whose core mission is the development and promotion of best practice, are best placed to guide and deliver medical education to their members.
       
  • Maternal Implications of Breastfeeding: A Review for the Internist
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Maryam Sattari, Janet R. Serwint, David M. LevineAbstractBreastfeeding seems to be a low-cost intervention that provides both short- and long-term health benefits for the breastfeeding woman. Interventions to support breastfeeding can increase its rate, exclusivity, and duration. Internists often have a longitudinal relationship with their patients and can be important partners with obstetricians and pediatricians in advocating for breastfeeding. To play their unique and critical role in breastfeeding promotion, internists need to be knowledgeable about breastfeeding and its maternal health benefits. In this paper, we review the short- and long-term maternal health benefits of breastfeeding. We also discuss special considerations in the care of breastfeeding women for the internist.
       
  • Reactive, Holistic, Proactive: Practical Applications of the AAIM Learning
           and Working Environment Conceptual Model
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Rebecca C. Jaffe, Christina R. Bergin, Lawrence K. Loo, Simran Singh, Brian Uthlaut, Susan A. Glod, Emily Fondhan, Alyssa McManamon, Sara L. Wallach, Karen Hamad, Katherine Walsh, Bethany Gentilesco
       
  • America's Health Care System is Broken: What Went Wrong and How We Can Fix
           It. Part 3: Hospitals and Doctors
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Edward P. HofferAbstractThirty-two percent of US health care spending goes to hospital care, and 20% goes to physicians’ charges. The cost of hospital care in the United States is 2-3 times greater than in most similar countries. A large part of the high cost is due to a very large administrative overhead. Both higher quality and lower cost would be achieved if complex procedures were done in fewer centers. Hospitals with a geographic or prestige monopoly receive higher payments than warranted. As physicians are increasingly employed by hospitals rather than independent, costs go up with no added benefit to patients. The United States has too many specialists and too few primary care physicians. Practice guidelines are slanted to favor expensive treatments, often with little solid evidence behind the recommendations.
       
  • Graduate Medical Education's Tower of Babel
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): David W. Young
       
  • A New Gender-Neutral Honorific: 'RP'
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Alexander Ladenheim, Gary P. Wormser
       
  • The Case for Being a Medical Conservative
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): John Mandrola, Adam Cifu, Vinay Prasad, Andrew Foy
       
  • Prescribing Statins to Reduce Cardiovascular Disease: 10 Common
           Misconceptions
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): David S. Schade, Lynda Shey, R. Philip Eaton
       
  • Bias in Medicine
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Joseph S. Alpert
       
  • Cataracts in the Eyesight of Cassatt
    • Abstract: Publication date: August 2019Source: The American Journal of Medicine, Volume 132, Issue 8Author(s): Jagdeep Singh Gandhi
       
  • Successful Implementation of Healthful Nutrition Initiatives into
           Hospitals
    • Abstract: Publication date: Available online 5 September 2019Source: The American Journal of MedicineAuthor(s): Monica Aggarwal, Ariel Grady, Daya Desai, Katrina Hartog, Lilian Correa, Robert J. Ostfeld, Andrew M. Freeman, Michelle McMacken, Eugenia Gianos, Koushik Reddy, Columbus Batiste, Christopher Wenger, Ron Blankstein, Kim Williams, Kathleen Allen, Rebecca M. Seifried, Neal D. BarnardAbstractPoor dietary quality is a leading contributor to mortality in the United States and to most cardiovascular risk factors. By providing education on lifestyle changes and specifically, dietary changes, hospitals have the opportunity to use the patient experience as a “teachable moment.” The food options provided to inpatients and outpatients can be a paradigm for patients to follow upon discharge from the hospital. There are hospitals in the United States that are showcasing novel ways to increase awareness of optimal dietary patterns and can serve as a model for hospitals nationwide.
       
  • Aligning Medical Student Curriculum with Practice Quality Goals: Impacts
           on Quality Metrics and Practice Capacity for Students
    • Abstract: Publication date: Available online 4 September 2019Source: The American Journal of MedicineAuthor(s): Amy W. Shaheen, Kelly Bossenbroek Fedoriw, Susanna Khachaturyan, Beat Steiner, Julie Golding, Julie S. Byerley, Gary L. Beck Dallaghan
       
  • Comments on “Vaccination in the Adult Patient Infected with
           HIV”
    • Abstract: Publication date: Available online 3 September 2019Source: The American Journal of MedicineAuthor(s): Martin Michaud, Lucie Bidouze, Sophie Ancellin, Florian Catros, Joshua Davis, Francis Gaches
       
  • Post-operative Atrial Fibrillation following Noncardiac Surgery Increases
           Risk of Stroke
    • Abstract: Publication date: Available online 30 August 2019Source: The American Journal of MedicineAuthor(s): Anoop N. Koshy, Garry Hamilton, James Theuerle, Andrew W Teh, Hui-Chen Han, Paul J. Gow, Han S Lim, Vincent Thijs, Omar FarouqueAbstractBackgroundNew-onset post-operative atrial fibrillation is well recognized to be an adverse prognostic marker in patients undergoing noncardiac surgery. Whether post-operative atrial fibrillation confers an increased risk of stroke remains unclear.MethodsA systematic review and meta-analysis was performed to assess the risk of stroke after post-operative atrial fibrillation in noncardiac surgery. MEDLINE, Cochrane and EMBASE databases were searched for articles published up to May 2019 for studies of patients undergoing noncardiac surgery that reported incidence of new atrial fibrillation and stroke. Event rates from individual studies were pooled and risk ratios (RR) were pooled using a random-effects model.ResultsFourteen studies of 3,536,291 patients undergoing noncardiac surgery were included in the quantitative analysis (mean follow-up 1.4 ± 1 year). New atrial fibrillation occurred in 26,046 (0.74%) patients with a higher incidence following thoracic surgery. Stroke occurred in 279 (1.5%) and 6199 (0.4%) patients, with and without post-operative atrial fibrillation, respectively. On pooled analysis, post-operative atrial fibrillation was associated with a significantly increased risk of stroke (RR 2.51, 95%CI 1.76–3.59) with moderate heterogeneity. The stroke risk was significantly higher with atrial fibrillation following non-thoracic compared to thoracic surgery (RR 3.09 vs RR 1.95; p = 0.01).ConclusionNew post-operative atrial fibrillation following noncardiac surgery was associated with a 2.5-fold increase in the risk of stroke. This risk was highest among patients undergoing non-thoracic noncardiac surgery. Given the documented efficacy of newer anticoagulants, randomized controlled trials are warranted to assess whether they can reduce the risk of stroke in these patients.
       
  • The Fugitive Finding: Acute Infectious Aortitis in a Patient with
           Persistent MRSA Bacteremia
    • Abstract: Publication date: Available online 30 August 2019Source: The American Journal of MedicineAuthor(s): Daniel J. DeSantis, Matthew C. Russell, Anthony W. KellerAbstractMethicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of bacteremia and of metastatic infections such as endocarditis, resulting in significant morbidity and mortality.1 We present a patient with persistent MRSA bacteremia despite antibiotic therapy. Although initial TEE was unremarkable, follow-up TEE confirmed infectious aortitis, illustrating the importance of repeated examination and imaging.
       
  • An unusual cause of stroke: Neurosarcoidosis
    • Abstract: Publication date: Available online 29 August 2019Source: The American Journal of MedicineAuthor(s): Sijie Jason Wang
       
  • Vitamin C and Thiamine for Sepsis and Septic Shock
    • Abstract: Publication date: Available online 28 August 2019Source: The American Journal of MedicineAuthor(s): Anna B. Mitchell, Tenley E. Ryan, Amanda R. Gillion, Lindsey D. Wells, Muthiah P. MuthiahAbstractBackgroundSepsis and septic shock are medical emergencies resulting in significant morbidity and mortality. Intravenous (IV) vitamin C, thiamine, and hydrocortisone have shown promise in reducing hospital mortality. The Memphis Veterans Affairs Medical Center (VAMC) similarly implemented this regimen, called the vitamin C protocol, for patients presenting in sepsis or septic shock in the intensive care unit (ICU).MethodsThis retrospective study in Veteran ICU patients with sepsis or septic shock compared outcomes of patients treated with IV vitamin C, thiamine, and hydrocortisone (treatment) with those who received IV hydrocortisone alone (control). Data was propensity matched to ensure comparability at baseline. The Sequential Organ Failure Assessment (SOFA) score was calculated at day of diagnosis (day 0) and daily for 3 subsequent days.ResultsHospital mortality, the primary outcome, did not differ significantly between groups. Secondary outcomes including ICU, 28-day, and 60-day mortality were also not different, nor were vasopressor duration or hospital length of stay. However, ICU length of stay was significantly reduced in the treatment group compared to control (7.1 vs 15.6 days, respectively, p = 0.04).ConclusionsAlthough no significant mortality benefit was observed, the vitamin C protocol was not associated with patient harm. In this Veteran population, there was reduced ICU length of stay, suggesting possible benefit. Though further investigation is warranted, utilization of IV vitamin C, thiamine, and hydrocortisone in patients with sepsis or septic shock may be a treatment option worth considering.
       
  • Changing Learning Objectives for Teaching Physical Examination at the
           Medical School Level
    • Abstract: Publication date: Available online 23 August 2019Source: The American Journal of MedicineAuthor(s): Danial M. Gelfman
       
  • Not a Grave Finding: Thymic Hyperplasia in the Setting of Graves' Disease
    • Abstract: Publication date: Available online 23 August 2019Source: The American Journal of MedicineAuthor(s): Michael Voss, Zeb Ijaz Saeed, Diane Donegan MB Bch
       
  • Cold Case: Mystery in the Midwest of Metastatic Tuberculous Abscesses
    • Abstract: Publication date: Available online 23 August 2019Source: The American Journal of MedicineAuthor(s): Matthew Enriquez, Moira McNulty
       
  • Vacation as a Duty Hour Policy Lever
    • Abstract: Publication date: Available online 23 August 2019Source: The American Journal of MedicineAuthor(s): John W. Urwin
       
  • Co-Management by Hospitalists: Why it makes clinical and fiscal sense
    • Abstract: Publication date: Available online 23 August 2019Source: The American Journal of MedicineAuthor(s): Nidhi Rohatgi, Kevin Schulman, Neera Ahuja
       
  • The Congestion-Creatinine Interplay in Acute Heart Failure; Time to Move
           up to the Next Level
    • Abstract: Publication date: Available online 23 August 2019Source: The American Journal of MedicineAuthor(s): Amir Kazory
       
  • Fifteen years trends of cardiogenic shock and mortality in patients with
           diabetes and acute coronary syndromes
    • Abstract: Publication date: Available online 22 August 2019Source: The American Journal of MedicineAuthor(s): Marco Dauriz, Nuccia Morici, Lucio Gonzini, Donata Lucci, Antonio Di Chiara, Alessandro Boccanelli, Zoran Olivari, Gianni Casella, Leonardo De Luca, Pierluigi Temporelli, Stefano De Servi, Enzo Bonora, Stefano SavonittoAbstractPurposeTo examine time trends of management and mortality of acute coronary syndrome patients with associated diabetes mellitus.MethodsWe analyzed data from 5 nationwide registries established between 2001 and 2014, including consecutive acute coronary syndrome patients admitted to the Italian Intensive Cardiac Care Units.ResultsOut of 28,225 participants, 8521 (30.2%) had diabetes: as compared to patients without diabetes, they were older and had significantly higher rates of prior myocardial infarction and comorbidities (all p 
       
  • A man with a clot on his platelets - adrenal carcinoma with complete caval
           thrombosis causing dynamic right ventricular inflow obstruction
    • Abstract: Publication date: Available online 20 August 2019Source: The American Journal of MedicineAuthor(s): Anissa McClelland, Amit K J Mandal, Fady Zakharious, Constantinos G Missouris
       
  • Innovative solutions and Insights to Phlebitis Prevention
    • Abstract: Publication date: Available online 20 August 2019Source: The American Journal of MedicineAuthor(s): Shu Yun Heng, Robert Tze-Jin Yap, Duncan Angus McGrouther
       
  • Does Ivabradine Decrease Cardiovascular Deaths in Heart Failure
           Patients'
    • Abstract: Publication date: Available online 20 August 2019Source: The American Journal of MedicineAuthor(s): Thomas A. Marciniak, Dan Atar, Victor SerebruanyAbstractBackgroundIvabradine, a heart rate slowing drug used to treat heart failure and (in Europe) angina, had varying impacts upon cardiovascular events in its three large outcome trials. FDA analyses may explain the reasons for the variability.MethodsAn FDA reviewer analyzed the raw data from the three trials using logistic regressions to assess interactions between ivabradine and other drugs and forest plots to display dose responses.ResultsIvabradine in its SHIFT heart failure trial shows a significant interaction with loop diuretics with a beneficial impact upon cardiovascular deaths (odds ratio 0.61, 95% confidence interval 0.42 – 0.87, p = 0.007). This favorable effect is supported by similar interactions in the other two trials (BEAUTIFUL, SIGNIFY) and by a dose response for loop diuretics interacting with ivabradine in the SHIFT and BEAUTIFUL trials. The interaction is not related to heart failure severity.ConclusionIvabradine used concomitantly with a loop diuretic has a beneficial impact upon cardiovascular death.
       
  • Diagnosing Sepsis: QSOFA is Not the Tool We’re Looking For
    • Abstract: Publication date: Available online 20 August 2019Source: The American Journal of MedicineAuthor(s): Nathan S. Cutler
       
  • Losing my mind: an uncommon presentation of Cushing’s disease
    • Abstract: Publication date: Available online 20 August 2019Source: The American Journal of MedicineAuthor(s): Andre Teck Huat Tan, Yen Ling Jocelyn Wong, Shuenn Chiang Soo
       
  • A randomized controlled trial on carbohydrate antigen 125-guided diuretic
           treatment versus usual care in patients with acute heart failure and renal
           dysfunction
    • Abstract: Publication date: Available online 15 August 2019Source: The American Journal of MedicineAuthor(s): Julio Núñez, Pau Llàcer, Sergio García-Blas, Clara Bonanad, Silvia Ventura, José María Núñez, Ruth Sánchez, Lorenzo Fácila, Rafael de la Espriella, Juana María Vaquer, Alberto Cordero, Mercè Roqué, Carlos Chamorro, Vicent Bodi, Ernesto Valero, Enrique Santas, María del Carmen Moreno, Gema Miñana, Arturo Carratalá, Enrique RodríguezAbstractBackgroundThe optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125 guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation.MethodsThis multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into two groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-guided group (n = 79), and to clinical evaluation in the usual care group (n = 81). Changes in estimated glomerular filtration rate (eGFR) at 72 and 24 h were the co-primary endpoints, respectively.ResultsThe mean age was 78 ± 8 years, the median amino-terminal pro-brain natriuretic peptide was 7765 pg/mL, and the mean eGFR was 33.7 ± 11.3 mL/min/1.73m2. Over 72 h, the CA125-guided group received higher furosemide equivalent dose compared to usual care (p = 0.011), which translated into higher urine volume (p = 0.042). Moreover, patients in the active arm with CA125 > 35 U/mL received the highest furosemide equivalent dose (p 
       
  • Pseudohyperkalemia in Chronic Lymphocytic Leukemia
    • Abstract: Publication date: Available online 15 August 2019Source: The American Journal of MedicineAuthor(s): Alon Bnaya, Rosa Ruchlemer, Eyal Itzkowitz, Ezra Gabbay, Shavit Linda
       
  • ”A curious case of endocarditis and liver abscess in a previously
           healthy man”
    • Abstract: Publication date: Available online 14 August 2019Source: The American Journal of MedicineAuthor(s): Michael Angarone, Baljash Cheema, Sean Connolly, Nicholas Volpe
       
  • DRESS masquerading as acute cholecystitis
    • Abstract: Publication date: Available online 14 August 2019Source: The American Journal of MedicineAuthor(s): Adinia Santosa, Sam Yang Shiyao, Nisha Suyien Chandran
       
  • Half and half nails
    • Abstract: Publication date: Available online 14 August 2019Source: The American Journal of MedicineAuthor(s): Shashank Singh, Mandy Sue Silver, Monika Aleksandra Gasiorek, Abhilash Koratala
       
  • Recurrent Pericarditis as an Initial Presentation of Rheumatoid Arthritis
    • Abstract: Publication date: Available online 14 August 2019Source: The American Journal of MedicineAuthor(s): Georges El Hasbani, Basel K Masri, Abdallah G Rebeiz, Imad Uthman
       
  • Cushing's disease in a patient with MEN 2B syndrome
    • Abstract: Publication date: Available online 14 August 2019Source: The American Journal of MedicineAuthor(s): Ivan Kruljac, Nina Dabelić, Domagoj Marjan, Kristina Blaslov, Božidar Perić, Gorana Mirošević, Davor Vagić, Milan Vrkljan
       
  • Splenic vein thrombosis – caught in the middle
    • Abstract: Publication date: Available online 13 August 2019Source: The American Journal of MedicineAuthor(s): Ami Schattner, Yair Glick
       
  • Scientific Authors in a Changing World of Scholarly Communication: What
           Does the Future Hold'
    • Abstract: Publication date: Available online 13 August 2019Source: The American Journal of MedicineAuthor(s): Gyorgy Baffy, Michele M. Burns, Beatrice Hoffmann, Subha Ramani, Sunil Sabharwal, Jonathan F. Borus, Susan Pories, Stuart F. Quan, Julie R. IngelfingerAbstractScholarly communication in science, technology and medicine has been organized around journal-based scientific publishing for the past 350 years. Scientific publishing has unique business models and includes stakeholders with conflicting interests – publishers, funders, libraries, and scholars who create, curate, and consume the literature. Massive growth and change in scholarly communication, coinciding with digitalization, have amplified stresses inherent in traditional scientific publishing as evidenced by overwhelmed editors and reviewers, increased retraction rates, emergence of pseudo-journals, strained library budgets, and debates about the metrics of academic recognition for scholarly achievements. Simultaneously, several open access models are gaining traction and online technologies offer opportunities to augment traditional tasks of scientific publishing, develop integrated discovery services, and establish global and equitable scholarly communication through crowdsourcing, software development, big data management and machine learning. These rapidly evolving developments raise financial, legal and ethical dilemmas that require solutions while successful strategies are difficult to predict. Key challenges and trends are reviewed from the authors' perspective about how to engage the scholarly community in this multifaceted process.
       
  • A possible and simple response to physician burnout
    • Abstract: Publication date: Available online 13 August 2019Source: The American Journal of MedicineAuthor(s): Joseph S. Alpert
       
  • Pain Neurology
    • Abstract: Publication date: Available online 13 August 2019Source: The American Journal of MedicineAuthor(s): Victor C. Wang, William J. MullallyAbstractPain is often the initial complaint for which patients seek medical care presenting both a diagnostic and therapeutic challenge to the primary care provider. The appreciation of pain is not merely the result of abnormal sensory stimulation causing an unpleasant sensation but rather a combination of the recognition of the somatic discomfort in association with an emotional response to that discomfort. The perception of pain and the extent of distress and disability can vary depending on previous experience, cultural background, situational factors, and comorbid psychiatric disease. While acute pain is usually the result of tissue damage, that is not always the case as evidenced by the primary headache disorders. Chronic pain may be the result of an injury, irreversible underlying disease or clinical conditions such as fibromyalgia for which the mechanism remains unclear. Treatment of the underlying cause will usually effect a resolution or improvement in the pain but when the discomfort persists a consultation with a neurologist or pain management specialist should be considered.
       
  • Misdiagnosis of liver abscess owing to misunderstood culture results
    • Abstract: Publication date: Available online 13 August 2019Source: The American Journal of MedicineAuthor(s): Kai Uehara, Yukinori Harada
       
  • Salt, No Salt or Less Salt For Heart Failure Patients'
    • Abstract: Publication date: Available online 13 August 2019Source: The American Journal of MedicineAuthor(s): Muhammad Shahzeb Khan, Daniel W Jones, Javed ButlerAbstractRestricting dietary sodium is a common recommendation given by clinicians to heart failure patients, one supported by current guidelines. However, the quality of evidence for this recommendation is suboptimal and there is no consensus on the optimal level of sodium intake. Though excessive sodium intake is associated with left ventricular hypertrophy and hypertension, recent data have suggested that very low sodium intake is paradoxically associated with worse heart failure outcomes. This is possibly explained by the association between low sodium intake and activation of the sympathetic and renin-angiotensin-aldosterone systems. Nevertheless, sodium restriction is routinely recommended and remains a cornerstone of heart failure and blood pressure therapy. In this editorial we discuss the pros and cons of sodium restriction for heart failure patients from the current literature.
       
  • Prion Problem: A Rapidly Progressive Dementia
    • Abstract: Publication date: Available online 13 August 2019Source: The American Journal of MedicineAuthor(s): Marshall Miller
       
  • Rapid diagnosis of infective endocarditis using pocket size ultrasound
    • Abstract: Publication date: Available online 13 August 2019Source: The American Journal of MedicineAuthor(s): Dan Haberman, Meital Zikry, Natasha Kozak, Jacob George, Sara Shimoni
       
  • New-onset atrial fibrillation among patients with infection in the
           emergency department: A multicentre cohort study of one-year stroke risk
    • Abstract: Publication date: Available online 9 August 2019Source: The American Journal of MedicineAuthor(s): Tobias Graversgaard Hansen, Anton Pottegård MScPharm, Axel Brandes, Ulf Ekelund, Helene Kildegaard Jensen, Jakob Lundager Forberg, Mikkel Brabrand, Annmarie Touborg LassenAbstractBackgroundPatients with new-onset atrial fibrillation in relation to infection are frequent in emergency departments (ED) and may require antithrombotic therapy due to increased risk of stroke. Our objective was to describe the one-year risk of stroke in ED patients with infection, new-onset atrial fibrillation and no antithrombotic therapy.MethodsPopulation-based cohort study at four EDs in Denmark and Sweden. Atrial fibrillation was identified by ECG upon arrival at the ED and infection was identified by discharge diagnosis. Patient history was followed for 12 months or until initiation of oral anticoagulant therapy, ischemic stroke or death. Primary outcome was stroke within 12 months compared to patients with infection and no atrial fibrillation.Results15,505 patients were included in analysis. 48.7% were male and the median age was 71 (IQR, 56–83). Among the included patients, 2107 (13.6%) had atrial fibrillation of any kind and 822 (39.0%) of these had new-onset atrial fibrillation with a median CHA2DS2-VASc score of 3 (IQR 2–4).New-onset atrial fibrillation during infection showed an absolute post-discharge one-year risk of stroke of 2.7% (95% CI 1.6–4.2), corresponding to a crude HR of 1.4 (95% CI 0.9–2.3), a sex and age adjusted HR of 1.0 (95% CI 0.6–1.6) and a CHA2DS2-VASc adjusted HR of 1.1 (95% CI, 0.7–1.8) compared to patients with infection, but no atrial fibrillation.ConclusionsED patients with infection and new-onset atrial fibrillation without current OAC therapy had a 2.7% absolute one-year risk of stroke. Stroke events were mainly related to sex and age and risk factors identified by the CHA2DS2-VASc score.
       
  • Lessons on Doctoring from Where There Is No Doctor
    • Abstract: Publication date: Available online 8 August 2019Source: The American Journal of MedicineAuthor(s): Matthew M. Dacso, Peter Just, Clifford C. Dacso
       
  • Ovarian Vein Thrombosis in an Elderly Female with Pyelonephritis
    • Abstract: Publication date: Available online 8 August 2019Source: The American Journal of MedicineAuthor(s): Katherine Bruening, Sarah Laper, James Pile
       
  • Early Effects of Starting Doses of Enalapril in Patients with Chronic
           Heart Failure in the SOLVD Treatment Trial
    • Abstract: Publication date: Available online 8 August 2019Source: The American Journal of MedicineAuthor(s): Phillip H. Lam, Milton Packer, Gregg C. Fonarow, Charles Faselis, Richard M. Allman, Charity J. Morgan, Steven Singh, Bertram Pitt, Ali AhmedAbstractBackgroundIn the Studies of Left Ventricular Dysfunction (SOLVD) Treatment trial, similar clinical benefits were observed between starting doses of enalapril and the target dose achieved by post-randomization up-titration. In our current analysis, protecting the randomization, we examined the early effects of starting doses of enalapril.Methods2569 patients with mild-to-moderate chronic heart failure with reduced ejection fraction (HFrEF; ejection fraction ≤ 35%) were randomized to receive starting doses (5–10 mg/day) of placebo (n = 1284) or enalapril (n = 1285). At day 14, both study drugs were blindly up-titrated to the target dose (20 mg/day). Overall, 89% (2284/2569) of the patients returned for dose up-titration, which was achieved in 56% (1444/2248), 48% (696/1444) of whom were in the enalapril group. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes in the enalapril group were estimated.ResultsHRs (95% CIs) for all-cause mortality, heart failure hospitalization, and the combined endpoint of heart failure hospitalization or all-cause mortality at 14 days after randomization were 0.80 (0.32–2.03), 0.63 (0.35–1.12), and 0.65 (0.39–1.06) 0.82, respectively. Corresponding HRs (95% CIs) at 30 days were (0.41–1.67), 0.43 (0.27–0.68), and 0.43 (0.27–0.68). The magnitude of these early effects of starting doses of enalapril is similar to its previously reported long-term effects at the target dose.ConclusionThese data suggest that in stable ambulatory patients with heart failure with reduced ejection fraction, the magnitude of the early effect of starting doses of enalapril is similar to that observed during longer-term therapy with the target doses of the drug.
       
  • Take home messages from the recently updated American Heart Association
           (AHA)/American College of Cardiology (ACC) guidelines for atrial
           fibrillation
    • Abstract: Publication date: Available online 8 August 2019Source: The American Journal of MedicineAuthor(s): Joseph S. Alpert
       
  • Routine Microbiologic Studies of Pleural Fluid Specimens in Cancer
           Patients
    • Abstract: Publication date: Available online 8 August 2019Source: The American Journal of MedicineAuthor(s): Marshall Bailey, Georgie Eapen, David Ost, Roberto F. Casal, Carlos Jimenez, Saumil Datar, Sofia Molina, Lara Bashoura, Saadia A. Faiz, Diwakar D. Balachandran, Vickie R. Shannon, Ajay Sheshadri, Horiana B. GrosuAbstractBackgroundPatients who have pleural effusions typically undergo thoracentesis with examination of pleural fluid in their initial assessment. However, limited data are available on the diagnostic yield of pleural fluid bacterial cultures, fungal and acid-fast bacilli (AFB) smear and cultures in cancer patients.MethodsWe performed a retrospective cohort study of consecutive patients who had new onset pleural effusions and underwent an initial thoracentesis. The primary outcome was diagnostic yield of pleural fluid bacterial cultures, fungal and acid-fast bacilli smear and cultures.ResultsOf 1637 patients, 1547 (94%) had evidence of active malignancy and 1359 (83%) had evidence of metastatic disease. Of the 1637 patients, 542 (33%) had high clinical suspicion of pneumonia within 14 days prior to thoracentesis. Only 14 patients (1.1%) had positive pleural fluid bacterial cultures, and only 6 of these positive cultures met the criteria for true pleural space infection.ConclusionsThe incidence of positive results from pleural fluid bacterial, fungal and acid-fast bacilli in cancer populations is very low. Unless there is a suspicion for infection, microbiological analysis should be ordered selectively.
       
  • Errors in Analysis of Heart Failure Hospitalizations with Intravenous Iron
    • Abstract: Publication date: Available online 7 August 2019Source: The American Journal of MedicineAuthor(s): Ricky D. Turgeon, Michael R. Kolber
       
  • Point of Care Ultrasound for Internal Medicine Residency Training: A
           Position Statement from the Alliance of Academic Internal Medicine
    • Abstract: Publication date: Available online 7 August 2019Source: The American Journal of MedicineAuthor(s): Charles M. LoPresti, Trevor P. Jensen, Renee K. Dversdal, Donna J. Astiz
       
  • Pulmonary Manifestations of Inflammatory Bowel Disease
    • Abstract: Publication date: Available online 6 August 2019Source: The American Journal of MedicineAuthor(s): Annie Massart, Daniel P. HuntAbstractPulmonary manifestations of inflammatory bowel disease are increasingly recognized in patients with ulcerative colitis and Crohn’s disease. Most commonly, incidental abnormalities are noted on chest imaging or pulmonary function tests. Although clinically significant pulmonary disease is less common, it can carry significant morbidity for patients. We review the presenting symptoms, workup, and management for several of the more common forms of inflammatory bowel disease-related pulmonary disease. Increased awareness of the spectrum of extraintestinal inflammatory bowel disease will help providers more readily recognize this phenomenon in their own patients and more comprehensively address the protean sequelae of inflammatory bowel disease.
       
 
 
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