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  Subjects -> MEDICAL SCIENCES (Total: 7798 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (196 journals)
    - ANAESTHESIOLOGY (111 journals)
    - CARDIOVASCULAR DISEASES (323 journals)
    - CHIROPRACTIC, HOMEOPATHY, OSTEOPATHY (21 journals)
    - COMMUNICABLE DISEASES, EPIDEMIOLOGY (210 journals)
    - DENTISTRY (262 journals)
    - DERMATOLOGY AND VENEREOLOGY (157 journals)
    - EMERGENCY AND INTENSIVE CRITICAL CARE (116 journals)
    - ENDOCRINOLOGY (146 journals)
    - FORENSIC SCIENCES (38 journals)
    - GASTROENTEROLOGY AND HEPATOLOGY (173 journals)
    - GERONTOLOGY AND GERIATRICS (129 journals)
    - HEMATOLOGY (145 journals)
    - HYPNOSIS (4 journals)
    - INTERNAL MEDICINE (151 journals)
    - LABORATORY AND EXPERIMENTAL MEDICINE (94 journals)
    - MEDICAL GENETICS (59 journals)
    - MEDICAL SCIENCES (2005 journals)
    - NURSES AND NURSING (316 journals)
    - OBSTETRICS AND GYNECOLOGY (194 journals)
    - ONCOLOGY (360 journals)
    - OPHTHALMOLOGY AND OPTOMETRY (127 journals)
    - ORTHOPEDICS AND TRAUMATOLOGY (159 journals)
    - OTORHINOLARYNGOLOGY (81 journals)
    - PATHOLOGY (100 journals)
    - PEDIATRICS (257 journals)
    - PHYSICAL MEDICINE AND REHABILITATION (148 journals)
    - PSYCHIATRY AND NEUROLOGY (781 journals)
    - RADIOLOGY AND NUCLEAR MEDICINE (187 journals)
    - RESPIRATORY DISEASES (96 journals)
    - RHEUMATOLOGY (66 journals)
    - SPORTS MEDICINE (73 journals)
    - SURGERY (371 journals)
    - UROLOGY, NEPHROLOGY AND ANDROLOGY (142 journals)

MEDICAL SCIENCES (2005 journals)                  1 2 3 4 5 6 7 8 | Last

Showing 1 - 200 of 3562 Journals sorted alphabetically
16 de Abril     Open Access  
3D Printing in Medicine     Open Access   (Followers: 1)
AADE in Practice     Hybrid Journal   (Followers: 5)
ABCS Health Sciences     Open Access   (Followers: 3)
Abia State University Medical Students' Association Journal     Full-text available via subscription  
ACIMED     Open Access   (Followers: 1)
ACS Medicinal Chemistry Letters     Hybrid Journal   (Followers: 41)
Acta Bio Medica     Full-text available via subscription   (Followers: 2)
Acta Bioethica     Open Access  
Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
Acta Facultatis Medicae Naissensis     Open Access  
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Medica (Hradec Králové)     Open Access  
Acta Medica Bulgarica     Open Access  
Acta Medica Colombiana     Open Access   (Followers: 1)
Acta Médica Costarricense     Open Access   (Followers: 2)
Acta Medica Indonesiana     Open Access  
Acta Medica International     Open Access  
Acta medica Lituanica     Open Access  
Acta Medica Marisiensis     Open Access  
Acta Medica Martiniana     Open Access  
Acta Medica Nagasakiensia     Open Access  
Acta Medica Peruana     Open Access   (Followers: 2)
Acta Médica Portuguesa     Open Access  
Acta Medica Saliniana     Open Access  
Acta Scientiarum. Health Sciences     Open Access   (Followers: 1)
Acupuncture & Electro-Therapeutics Research     Full-text available via subscription   (Followers: 4)
Acupuncture and Natural Medicine     Open Access  
Addiction Science & Clinical Practice     Open Access   (Followers: 7)
Addictive Behaviors Reports     Open Access   (Followers: 8)
Adıyaman Üniversitesi Sağlık Bilimleri Dergisi / Health Sciences Journal of Adıyaman University     Open Access  
Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi     Open Access  
Advanced Biomedical Research     Open Access  
Advanced Health Care Technologies     Open Access   (Followers: 4)
Advanced Science, Engineering and Medicine     Partially Free   (Followers: 7)
Advances in Bioscience and Clinical Medicine     Open Access   (Followers: 5)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29)
Advances in Life Course Research     Hybrid Journal   (Followers: 8)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Medical Education and Practice     Open Access   (Followers: 26)
Advances in Medical Ethics     Open Access  
Advances in Medical Research     Open Access  
Advances in Medical Sciences     Hybrid Journal   (Followers: 6)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Medicine     Open Access   (Followers: 3)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4)
Advances in Molecular Oncology     Open Access   (Followers: 2)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7)
Advances in Parkinson's Disease     Open Access  
Advances in Phytomedicine     Full-text available via subscription  
Advances in Preventive Medicine     Open Access   (Followers: 6)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20)
Advances in Regenerative Medicine     Open Access   (Followers: 2)
Advances in Skeletal Muscle Function Assessment     Open Access  
Advances in Therapy     Hybrid Journal   (Followers: 5)
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)
Advances in Wound Care     Hybrid Journal   (Followers: 10)
Aerospace Medicine and Human Performance     Full-text available via subscription   (Followers: 11)
African Health Sciences     Open Access   (Followers: 3)
African Journal of Biomedical Research     Open Access   (Followers: 1)
African Journal of Clinical and Experimental Microbiology     Open Access   (Followers: 2)
African Journal of Laboratory Medicine     Open Access   (Followers: 2)
African Journal of Medical and Health Sciences     Open Access   (Followers: 2)
African Journal of Trauma     Open Access   (Followers: 1)
Afrimedic Journal     Open Access   (Followers: 2)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
AIDS Research and Human Retroviruses     Hybrid Journal   (Followers: 8)
AJOB Primary Research     Partially Free   (Followers: 3)
AJSP: Reviews & Reports     Hybrid Journal  
Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 4)
Al-Azhar Assiut Medical Journal     Open Access  
Alexandria Journal of Medicine     Open Access   (Followers: 1)
Allgemeine Homöopathische Zeitung     Hybrid Journal   (Followers: 2)
Alpha Omegan     Full-text available via subscription  
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 3)
American Journal of Biomedical Engineering     Open Access   (Followers: 11)
American Journal of Biomedical Research     Open Access   (Followers: 2)
American Journal of Biomedicine     Full-text available via subscription   (Followers: 7)
American Journal of Chinese Medicine, The     Hybrid Journal   (Followers: 4)
American Journal of Clinical Medicine Research     Open Access   (Followers: 7)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Law & Medicine     Full-text available via subscription   (Followers: 11)
American Journal of Lifestyle Medicine     Hybrid Journal   (Followers: 5)
American Journal of Managed Care     Full-text available via subscription   (Followers: 11)
American Journal of Medical Case Reports     Open Access   (Followers: 1)
American Journal of Medical Sciences and Medicine     Open Access   (Followers: 4)
American Journal of Medicine     Hybrid Journal   (Followers: 46)
American Journal of Medicine and Medical Sciences     Open Access   (Followers: 1)
American Journal of Medicine Studies     Open Access   (Followers: 1)
American Journal of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American Journal of the Medical Sciences     Hybrid Journal   (Followers: 12)
American Journal on Addictions     Hybrid Journal   (Followers: 9)
American medical news     Free   (Followers: 3)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 5)
Amyloid: The Journal of Protein Folding Disorders     Hybrid Journal   (Followers: 5)
Anales de la Facultad de Medicina     Open Access  
Anales de la Facultad de Medicina, Universidad de la República, Uruguay     Open Access  
Anales del Sistema Sanitario de Navarra     Open Access   (Followers: 1)
Analgesia & Resuscitation : Current Research     Hybrid Journal   (Followers: 5)
Anatolian Clinic the Journal of Medical Sciences     Open Access  
Anatomica Medical Journal     Open Access  
Anatomical Science International     Hybrid Journal   (Followers: 3)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1)
Anatomy     Open Access   (Followers: 1)
Anatomy Research International     Open Access   (Followers: 2)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3)
Ankara Medical Journal     Open Access   (Followers: 2)
Ankara Üniversitesi Tıp Fakültesi Mecmuası     Open Access  
Annales de Pathologie     Full-text available via subscription  
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale     Full-text available via subscription   (Followers: 3)
Annals of African Medicine     Open Access   (Followers: 1)
Annals of Anatomy - Anatomischer Anzeiger     Hybrid Journal   (Followers: 2)
Annals of Bioanthropology     Open Access   (Followers: 4)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 18)
Annals of Biomedical Sciences     Full-text available via subscription   (Followers: 3)
Annals of Clinical Microbiology and Antimicrobials     Open Access   (Followers: 11)
Annals of Family Medicine     Open Access   (Followers: 14)
Annals of Ibadan Postgraduate Medicine     Open Access  
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Medicine     Hybrid Journal   (Followers: 12)
Annals of Medicine and Surgery     Open Access   (Followers: 7)
Annals of Microbiology     Hybrid Journal   (Followers: 11)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Saudi Medicine     Open Access  
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5)
Annals of The Royal College of Surgeons of England     Full-text available via subscription   (Followers: 3)
Annual Reports in Medicinal Chemistry     Full-text available via subscription   (Followers: 7)
Annual Reports on NMR Spectroscopy     Full-text available via subscription   (Followers: 4)
Annual Review of Medicine     Full-text available via subscription   (Followers: 16)
Anthropological Review     Open Access   (Followers: 23)
Anthropologie et santé     Open Access   (Followers: 5)
Antibiotics     Open Access   (Followers: 9)
Antibodies     Open Access   (Followers: 2)
Antibody Technology Journal     Open Access   (Followers: 1)
Anuradhapura Medical Journal     Open Access  
Anwer Khan Modern Medical College Journal     Open Access   (Followers: 2)
Apmis     Hybrid Journal   (Followers: 1)
Apparence(s)     Open Access   (Followers: 1)
Applied Clinical Research, Clinical Trials and Regulatory Affairs     Hybrid Journal  
Applied Medical Informatics     Open Access   (Followers: 10)
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Arak Medical University Journal     Open Access  
Archive of Clinical Medicine     Open Access   (Followers: 1)
Archive of Community Health     Open Access   (Followers: 1)
Archives Medical Review Journal / Arşiv Kaynak Tarama Dergisi     Open Access  
Archives of Medical and Biomedical Research     Open Access   (Followers: 3)
Archives of Medical Laboratory Sciences     Open Access   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Archives of Medicine and Surgery     Open Access  
Archives of Trauma Research     Open Access   (Followers: 3)
Archivos de Medicina (Manizales)     Open Access  
ArgoSpine News & Journal     Hybrid Journal  
Arquivos Brasileiros de Oftalmologia     Open Access  
Arquivos de Ciências da Saúde     Open Access  
Arquivos de Medicina     Open Access  
Ars Medica : Revista de Ciencias Médicas     Open Access  
ARS Medica Tomitana     Open Access   (Followers: 1)
Art Therapy: Journal of the American Art Therapy Association     Full-text available via subscription   (Followers: 13)
Arterial Hypertension     Open Access   (Followers: 1)
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 13)
Artificial Organs     Hybrid Journal   (Followers: 1)
ASHA Leader     Open Access  
Asia Pacific Family Medicine     Open Access   (Followers: 1)
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 10)
Asia Pacific Journal of Clinical Trials : Nervous System Diseases     Open Access  
Asian Bioethics Review     Full-text available via subscription   (Followers: 3)
Asian Biomedicine     Open Access   (Followers: 2)
Asian Journal of Cell Biology     Open Access   (Followers: 5)
Asian Journal of Health     Open Access   (Followers: 3)
Asian Journal of Medical and Biological Research     Open Access   (Followers: 4)
Asian Journal of Medical and Pharmaceutical Researches     Open Access   (Followers: 1)
Asian Journal of Medical Sciences     Open Access   (Followers: 2)
Asian Journal of Scientific Research     Open Access   (Followers: 3)
Asian Journal of Transfusion Science     Open Access   (Followers: 1)
Asian Medicine     Hybrid Journal   (Followers: 5)
Asian Pacific Journal of Cancer Prevention     Open Access  
ASPIRATOR : Journal of Vector-borne Disease Studies     Open Access  
Astrocyte     Open Access  
Atención Familiar     Open Access  
Atención Primaria     Open Access   (Followers: 1)
Atti della Accademia Peloritana dei Pericolanti - Classe di Scienze Medico-Biologiche     Open Access  
Audiology - Communication Research     Open Access   (Followers: 10)
Auris Nasus Larynx     Full-text available via subscription  
Australian Coeliac     Full-text available via subscription   (Followers: 1)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Journal of Medical Science     Full-text available via subscription   (Followers: 1)
Autopsy and Case Reports     Open Access  
Avicenna     Open Access   (Followers: 3)
Avicenna Journal of Clinical Medicine     Open Access  
Avicenna Journal of Medicine     Open Access   (Followers: 1)
Bangabandhu Sheikh Mujib Medical University Journal     Open Access   (Followers: 1)
Bangladesh Journal of Anatomy     Open Access   (Followers: 1)
Bangladesh Journal of Bioethics     Open Access  
Bangladesh Journal of Medical Biochemistry     Open Access   (Followers: 3)
Bangladesh Journal of Medical Education     Open Access   (Followers: 2)
Bangladesh Journal of Medical Microbiology     Open Access   (Followers: 3)
Bangladesh Journal of Medical Physics     Open Access  
Bangladesh Journal of Medical Science     Open Access  

        1 2 3 4 5 6 7 8 | Last

Journal Cover
American Journal of Medicine
Number of Followers: 46  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9343 - ISSN (Online) 1555-7162
Published by Elsevier Homepage  [3162 journals]
  • Prostate Abscesses and Staphylococcus aureus Bacteremia
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Ami Schattner, Talya Finn, Yair Glick, Ina Dubin
       
  • Development and Resolution of Cutaneous Lesions Caused by Black Fly Bites
           (Diptera: Simuliidae)
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Jerome Goddard, Patricia Stewart, Hunter Deerman, Tina M. Nations, Wendy C. Varnado
       
  • Adult-Onset Still's Disease: AClassic Presentation of a RareIllness
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Amrit K. Kamboj, Samantha M. Ryan, Mark J. Enzler
       
  • Strongyloides Hyperinfection
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Rhonda Dillon, David J. Riedel
       
  • Lesson Learned Through a Case of Pneumococcal Meningitis: Sometimes Doing
           Less Is More Harmful
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Ashish Verma, Muhammad Hassaan Shahid, Laura Youngblood
       
  • Diagnostic Dilemma: Carcinoid Syndrome
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Neil Beri, Amir Farid, Maria Galkin, William Lewis, Ezra Amsterdam
       
  • Improving Survival in Cardiogenic Shock: Is Impella the Answer'
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): James J. Glazier, Amir Kaki
       
  • Association of Dairy Consumption and 24-Hour Blood Pressure in Older
           Adults with Hypertension
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Alberto Lana, Jose R. Banegas, Pilar Guallar-Castillón, Fernando Rodríguez-Artalejo, Esther Lopez-GarciaABSTRACTBackgroundThe aim was to examine the association between habitual consumption of dairy products and 24-hour ambulatory blood pressure monitoring among older adults with hypertension.MethodsWe conducted an analysis of 715 community-living hypertensive adults age ≥60. Habitual dairy consumption was assessed with a validated diet history. Blood pressure was recorded by 24-hour ambulatory blood pressure monitoring; controlled blood pressure was defined as 24-hour blood pressure
       
  • Individual and Joint Effects of Pulse Pressure and Blood Pressure
           Treatment Intensity on Serious Adverse Events in the SPRINT Trial
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Ashok Krishnaswami, Dae Hyun Kim, Charles E. McCulloch, Daniel E. Forman, Mathew S. Maurer, Karen P. Alexander, Michael W. Rich PurposeThe objective of this study was to determine individual and joint effects of pulse pressure and blood pressure treatment intensity on serious adverse events in the Systolic Blood Pressure Intervention Trial.MethodsPulse pressure was calculated by subtracting diastolic blood pressure from systolic blood pressure. Blood pressure treatment intensity goal was ≤140mm Hg in the control arm and ≤120mm Hg in the intensive arm. The primary outcome was a 5-point composite of hypotension, syncope, electrolyte abnormalities, acute renal insufficiency, or injurious falls.ResultsIn 9361 trial participants, the incident rate for the primary outcome per 1000 person-years increased with higher pulse pressure category: ≤49 mmHg: 20.4 (17.2-24.1), 50-59 mmHg: 24.5 (21.3-28.2), 60-69 mmHg: 31.7 (27.7-36.2), ≥70 mmHg: 44.6 (39.8-49.9; Ptrend < .0001; hazard ratio [HR] of pulse pressure [every 10mm Hg] 1.23; 95% confidence interval [CI], 1.18-1.28). The intensive treatment arm had a higher incidence rate of serious adverse events than the control arm (34.2, 95% CI, 31.2-37.3, vs 26.0, 95% CI, 23.4-28.8, P = .0001; HR 1.32; 95% CI, 1.15-1.51). The combined effect was not significant in the relative risk scale (HR 0.97, Pinteraction = .48) but was significant in the risk difference scale (P = .027), contributing 2.5 additional serious adverse events per 1000 person-years for every 10mm Hg increase in pulse pressure in excess of the individual effects of pulse pressure and treatment intensity.ConclusionsWider pulse pressure and intensive blood pressure treatment were individually associated with the composite adverse event outcome. A modest effect modification of pulse pressure and treatment intensity led to additional adverse events when both were present. Clinicians should use caution when treating older patients with elevated pulse pressure to an intensive blood pressure treatment target.
       
  • A ‘Shocking’ Cause of Facial Edema
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Andrew Chua Tiu, Kamolyut Lapumnuaypol, Thita Chiasakul
       
  • On the Nose: Disseminated Mucormycosis
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Pierre Danneels, Rafael Mahieu, Mamoun Dib, Pierre Abgueguen, Valérie Rabier, Marion Klosek, Yohann Le Govic, Vincent Dubée
       
  • A Surprising Diagnosis: Syphilitic Gastritis and Hepatitis
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Christian L. Horn, Seyed Jalali, Joel Abbott, Michael T. Stein
       
  • Serious Cover-Up: Hodgkin's Lymphoma Masked by Organizing Pneumonia
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Amos Lal, Michael J. Davis, Jamal Akhtar, Yayan Chen, Steven Davis
       
  • Cardiovascular Disease Progression: A Target for Therapy'
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Jay N. Cohn Clinical research aimed at preventing cardiovascular disease has focused on the effect of interventions to reduce risk factors on the incidence of future morbid events. Disease progression, which likely serves as a necessary prerequisite for morbid events, has not served as a target for therapy. The Rasmussen Center at the University of Minnesota has, for the past 18 years, been performing a noninvasive cardiovascular evaluation in individuals with no history of cardiovascular disease. The studies, performed in 1 hour in one room, provide a comprehensive noninvasive assessment of the severity of functional and structural abnormalities in the small arteries, the large arteries and the left ventricle, the target organs for most cardiovascular morbid events. Preliminary follow-up data have revealed a striking relationship between the Disease Score, which represents the sum of the abnormal tests, and the risk of future morbid events. In order to develop strategies to prolong cardiovascular disease-free life expectancy, studies in early stages of disease aimed at slowing disease progression should be encouraged.
       
  • Dementia
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Seth A. Gale, Diler Acar, Kirk R. Daffner Dementia is any decline in cognition that is significant enough to interfere with independent, daily functioning. Dementia is best characterized as a syndrome rather than as one particular disease. The causes of dementia are myriad and include primary neurologic, neuropsychiatric, and medical conditions. It is common for multiple diseases to contribute to any one patient's dementia syndrome. Neurodegenerative dementias, like Alzheimer disease and dementia with Lewy bodies, are most common in the elderly, while traumatic brain injury and brain tumors are common causes in younger adults. While the recent decade has seen significant advancements in molecular neuroimaging, in understanding clinico-pathologic correlation, and in the development of novel biomarkers, clinicians still await disease-modifying therapies for neurodegenerative dementias. Until then, clinicians from varied disciplines and medical specialties are well poised to alleviate suffering, aggressively treat contributing conditions, employ medications to improve cognitive, neuropsychiatric, and motor symptoms, promote evidence-based brain-healthy behaviors, and improve overall quality of life for patients and families.
       
  • Accuracy and Efficacy of Hand-Held Echocardiography in Diagnosing Valve
           Disease: A Systematic Review
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Felix Thomas, Nir Flint, Saman Setareh-Shenas, Florian Rader, Sergio L. Kobal, Robert J. Siegel In recent years, advances in technology have enabled hand-held echocardiography (HHE) to generate high-quality 2-dimensional and color Doppler images. As these devices become smaller, simpler, and more affordable, the question of whether HHE can augment or replace auscultation as the primary mode of cardiovascular diagnosis has become increasingly more relevant. If widely implemented, HHE has the potential for significant cost savings and better resource utilization. This review examines studies comparing the sensitivities of auscultation, HHE, and standard echocardiography in detecting various valvular lesions and discusses why current evidence supports the use of HHE to augment the physical examination, which can lead to more reliable and rapid bedside diagnoses, triage, and appropriate treatment of structural cardiac abnormalities.
       
  • Psoriasis and Psoriatic Spectrum Disease: A Primer for the Primary Care
           Physician
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Jawad Bilal, Saad Ullah Malik, Irbaz Bin Riaz, Drew J.B. Kurtzman Psoriasis is a chronic, immune-mediated disorder that affects approximately 7.5 million people in the United States. Individuals with psoriasis may develop cutaneous, articular, and systemic manifestations, which are a source of significant morbidity and a heightened risk of mortality, and may adversely impact patient-reported quality of life measures. Psoriasis is now recognized as a risk factor for cardiovascular disease, metabolic syndrome, peripheral vascular disease, inflammatory bowel disease, certain malignancies, and chronic renal disease. Therefore, it has become increasingly relevant that primary care physicians have a basic working knowledge and an understanding of fundamental management principles of psoriasis. This review highlights the salient clinical features of psoriasis and psoriatic spectrum disease, emphasizing key updates with respect to systemic disease and associated conditions, and briefly outlines a therapeutic algorithm for the primary care physician.
       
  • Hardwired for Life' Implantable Defibrillator Dilemmas in Older
           Patients
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): James M. Beattie, James N. Kirkpatrick, Kristen K. Patton, Arnold R. Eiser
       
  • The United State of Medicine: Healing Identity Confusion
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Paula N. Stein, Andreas H. Smoller, PhD
       
  • Prescription of Statins to Women Poses New Clinical Challenges
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Madeline Pung, Janet Robishaw, Marc A. Pfeffer, Charles H. Hennekens
       
  • The Role of the Environment in Health Outcomes
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Joseph S. Alpert
       
  • Honoring a Patient: From Suspicion to Diagnosis
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Samuel Rosner, Emily R. Insetta
       
  • Is Frailty a Predictor of Outcomes in Elderly Inpatients with Acute Kidney
           Injury' A Prospective Cohort Study
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Sarah Morton, Alexander Isted, Pascale Avery, Joe Wang BackgroundFrailty and acute kidney injury are independently associated with an increased risk of morbidity and mortality. The degree of frailty can be assessed by the Clinical Frailty Score (CFS). This study assessed whether an individual's CFS was associated with acute kidney injury in acute elderly medical admissions and recorded the short-term outcomes.MethodsThis was a single-center prospective observational cohort study. All patients aged ≥65 years admitted under an acute medical take over 12 nonconsecutive days were included. Patient demographics, comorbidities, baseline CFS, and renal status on admission were recorded. Outcomes of death, length of stay, and hospital re-attendance were assessed 2 weeks following admission.ResultsOf 164 patients (77 males), 19% had acute kidney injury on admission and 22% were considered severely frail. Severe frailty was associated with acute kidney injury (P = .01) and death within 2 weeks (P = .01). Two-week mortality was highest among patients with both (36%).ConclusionThe incidence of acute kidney injury in “severely frail” acutely unwell elderly patients is significantly higher and associated with an increased short-term mortality. The CFS may be useful in acute illness to guide clinical decisions in elderly patients.
       
  • Use of Rivaroxaban in Obesity Cannot be Applied to Use of Dabigatran
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Danielle Trierweiler, Lauren Biehle
       
  • The Reply
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Joseph S. Alpert
       
  • Of Cardiac Holes and Crew Leaders
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Fernando Elijovich
       
  • The Reply
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Thomas E. MacMillan, Patrick Gudgeon, Paul M. Yip, Rodrigo B. Cavalcanti
       
  • Balancing Measures When Restricting Laboratory Testing
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Arjun Gupta
       
  • Developing Faculty in Emerging Areas of Interdisciplinary Research
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): David L. Coleman, Lisa R. Tannock, Michael Pignone, Alpesh N. Amin, Patricia W. Finn The availability of new techniques and technologies to answer important medical questions is accelerating at a breathtaking pace. In response to these exciting new opportunities, clinical departments, in general, and departments of medicine, in particular, have broadened their research portfolios. Organization of the traditional structures of clinical departments, research infrastructure, training programs, and rewards for faculty has only begun to catalyze emerging research areas such as artificial intelligence, bioinformatics, bioengineering, cell and tissue engineering, cost effectiveness, health services, implementation science, integrative epidemiology, medical informatics, nanomedicine, and quality improvement. Success in these emerging areas of research requires interdisciplinary collaboration on a much larger scale than in the past. The effectiveness of efforts to recruit, develop, mentor, and promote faculty in these exciting areas will be critical to the success of departmental and institutional research programs. We describe examples of initiatives from our 5 departments of medicine designed to develop and promote faculty conducting research in emerging interdisciplinary areas. We focus on core resources, training, organizational structures, and recognition and promotion. Faculty have a compelling opportunity and obligation to pursue emerging research areas that have the potential to further improve the prevention, diagnosis, and treatment of disease. As departments prepare to meet this exciting opportunity in the future, the lessons learned must inform investments in faculty development. Although many of the strategies outlined herein could and should expand beyond any individual department, departments of medicine have a distinct obligation and opportunity to lead this effort.
       
  • The Reply
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Milton Packer
       
  • Exercise Training in Obese Patients with Heart Failure: Time to Tackle the
           Burden
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Massimo Leggio, Augusto Fusco, Paolo Severi, Massimo Armeni, Stefania D'Emidio, Elisa Caldarone, Mario Lombardi, Maria Grazia Bendini, Andrea Mazza
       
  • Transient Loss of HIV-1 DNA in an HIV-1 Positive Patient After Kidney
           Transplantation: A Case Report
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Ana C. Paim, Stacey A. Rizza, Andrew D. Badley, Mikel Prieto, Sandra J. Taler, Pearlie P. Chong, Nathan W. Cummins
       
  • Pneumaturia and Nephrotic Syndrome Caused by a HiddenPelvic Malignancy
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Weijia Li, Barton Sanders, Ashita Tolwani
       
  • Intra-Abdominal Varix Rupture: A Life-Threatening Cause of Hemoperitoneum
    • Abstract: Publication date: October 2018Source: The American Journal of Medicine, Volume 131, Issue 10Author(s): Helen H. Lin, Adam M. Garber
       
  • Autonomic Disorders
    • Abstract: Publication date: Available online 9 October 2018Source: The American Journal of MedicineAuthor(s): Peter Novak Autonomic complaints are frequently encountered in clinical practice. They can be due to primary autonomic disorders or secondary to other medical conditions. Primary autonomic disorders can be categorized as orthostatic intolerance syndromes and small fiber neuropathies, the latter are associated with autonomic failure, pain, or their combinations. The review outlines orthostatic intolerance syndromes (neurally mediated syncope, orthostatic hypotension, postural tachycardia syndrome, inappropriate sinus tachycardia, orthostatic cerebral hypoperfusion syndrome and hypocapnic cerebral hypoperfusion) and small fiber neuropathies (sensory/autonomic/mixed, acute/subacute/chronic, idiopathic/secondary, inflammatory and non-inflammatory). Several specific autonomic syndromes (diabetic neuropathy, primary hyperhidrosis, paroxysmal sympathetic hyperactivity, autonomic dysreflexia), neurogenic bladder and gastrointestinal motility disorders are discussed as well.
       
  • Transitional care interventions for heart failure: what are the
           mechanisms'
    • Abstract: Publication date: Available online 6 October 2018Source: The American Journal of MedicineAuthor(s): David R. Thompson, Chantal F. Ski, Alexander M. Clark
       
  • Team-based primary care for the multimorbid patient: Matching complexity
           with complexity
    • Abstract: Publication date: Available online 6 October 2018Source: The American Journal of MedicineAuthor(s): Linnaea Schuttner, Michael Parchman
       
  • Aspirin use to prevent exertional cardiac arrest in athletes with high
           coronary artery calcium scores
    • Abstract: Publication date: Available online 5 October 2018Source: The American Journal of MedicineAuthor(s): Arthur J. Siegel, Timothy D. Noakes While proficient cardiac resuscitation has improved survival following cardiac arrest during road races in Japan, this accomplishment does not address coronary artery disease as the underlying cause of an increasing frequency of cardiac arrest in middle-aged males during marathons and ironman triathlons in the United States since the year 2000. Based on the high prevalence of subclinical coronary artery disease by cardiac computed tomography in endurance athletes with low conventional cardiac risk factor profiles, we recommend coronary artery calcium scores as a more reliable and independent predictor of incident cardiac events including death as validated among adults aged 30-46 years. Scores over 100 Agatston units indicate a 10-year cardiac risk of 7.5% at which additional measures for primary prevention are recommended including aspirin, as shown conclusively to reduce first myocardial infarctions in same-aged men in a prospective double-blind controlled trial. Targeted screening for subclinical coronary atherosclerosis with coronary artery calcium scores is prudent to guide appropriately dosed aspirin use to mitigate the increasing frequency of sports-related sudden cardiac death due to plaque rupture.
       
  • Sleep Disorders
    • Abstract: Publication date: Available online 4 October 2018Source: The American Journal of MedicineAuthor(s): Milena Pavlova, Véronique Latreille Sleep disorders are frequent and can have serious consequences on patients’ health and quality of life. While some sleep disorders are more challenging to treat, most can be easily managed with adequate interventions. We review the main diagnostic features of six major sleep disorders (insomnia, circadian rhythm disorders, sleep-disordered breathing, hypersomnia/narcolepsy, parasomnias, and restless legs syndrome/periodic limb movement disorder) to aid medical practitioners in screening and treating sleep disorders as part of clinical practice.
       
  • Spinal Emergencies in Primary Care Practice
    • Abstract: Publication date: Available online 3 October 2018Source: The American Journal of MedicineAuthor(s): Jacob M. Babu, Shyam A. Patel, Mark A. Palumbo, Alan H. Daniels Atraumatic spinal emergencies often present a diagnostic and management dilemma for healthcare practitioners. Spinal epidural abscess, cauda equina syndrome, and spinal epidural hematoma are conditions that can insidiously present to outpatient medical offices, urgent care centers, and emergency rooms. Unless a high level of clinical suspicion is maintained, these clinical entities may be initially misdiagnosed and mismanaged. Permanent neurologic sequela and even death can result if delays in appropriate treatment occur.A focused, critical review of 34 peer-reviewed articles was performed to identify current data regarding accurate diagnosis of spinal emergencies. This review highlights the key features of these three pathological entities with an emphasis on appropriate diagnostic strategy to intervene efficiently and minimize morbidity.•Time to decompression is an important factor correlated to outcomes, emphasizing early diagnosis•Irreversible neurologic sequelae can occur if there is initial misdiagnosis or delay in diagnosis•Managing bleeding dyscrasias can be an important first step in the treatment of epidural hematoma•Bowel/bladder symptoms and perianal numbness can differentiate sciatica from cauda equina syndrome
       
  • Behind the Curve: Late-Onset Axial Spondyloarthritis
    • Abstract: Publication date: Available online 3 October 2018Source: The American Journal of MedicineAuthor(s): Qin Xiang Ng, Benjamin Hooi, Wei Chuan Tan, Garvi Pandya
       
  • Corticosteroids in the management of severe coccidioidomycosis
    • Abstract: Publication date: Available online 2 October 2018Source: The American Journal of MedicineAuthor(s): Melisa R. Chang, Neha Chopra, David Beenhouwer, Matthew B. Goetz, Guy W. Soo Hoo BackgroundThere is limited data suggesting that recovery from severe pulmonary infection with Coccidioides may be hastened by the addition of systemic corticosteroids.MethodsA case report of two patients with persistent and progressive coccidioidomycosis who demonstrated a dramatic response to adjunctive corticosteroid therapy.ResultsBoth patients had Coccidioides immiitis cultured from respiratory samples. One was a 69 year old man who had been treated with combination fluconazole and liposomal amphotericin for over six weeks, with persistent fever and pneumonia. The other was a 61 year old man treated with fluconazole and then amphotericin for three weeks, with progression to acute respiratory distress syndrome and shock. Both received short courses of intravenous methylprednisolone and recovered to be discharged home.ConclusionAs opposed to associated hypersensitivity, corticosteroid treatment in these cases was directed at modulating the ongoing destructive effects of unchecked inflammation. Rapid improvement was noted in both cases and raises the possibility that the addition of systemic corticosteroids may hasten recovery in patients with severe coccidioidomycosis.
       
  • Follow the Beads: Fibromuscular Dysplasia
    • Abstract: Publication date: Available online 2 October 2018Source: The American Journal of MedicineAuthor(s): Vy K. Ly, Reza Manesh, Kesav Raghavan, Rabih M. Geha
       
  • Without Warning: Scleroderma Renal Crisis
    • Abstract: Publication date: Available online 2 October 2018Source: The American Journal of MedicineAuthor(s): Seth J. Lichtenstein, Michael J. Herring, Pravir V. Baxi, Richard I. Abrams, Stephen M. Korbet
       
  • Optimal Therapy for Unstable Pulmonary Embolism
    • Abstract: Publication date: Available online 2 October 2018Source: The American Journal of MedicineAuthor(s): Paul D. Stein, James E. Dalen, Fadi Matta, Mary J. HughesABSTRACTThere are no randomized controlled trials of thrombolytic therapy, pulmonary embolectomy or inferior vena cava (IVC) filters in patients with unstable pulmonary embolism (those in shock or on ventilator support). Yet, there are many investigations of these treatments based on retrospective cohort studies using administrative data from huge government and commercial databases. Extensive data from these cohort studies showed that thrombolytic therapy resulted in the lowest in-hospital all-cause mortality. The results of thrombolytic therapy were greatly improved if IVC filters were added. In fact, IVC filters decreased in-hospital all-cause mortality with anticoagulants alone or pulmonary embolectomy as well as thrombolytic therapy in adults of all ages with unstable pulmonary embolism. The IVC filters reduced mortality only if inserted on the day of admission or the next day, while the patients were unstable and in a fragile condition. We conclude that the best treatment for patients with unstable pulmonary embolism is thrombolytic therapy combined with an IVC filter inserted while in the fragile period, and this treatment is indicated in all unstable patients irrespective of age.
       
  • Burn Bright II: Reflections on solutions to burnout (Part two of a
           two-part series)
    • Abstract: Publication date: Available online 27 September 2018Source: The American Journal of MedicineAuthor(s): Mari Ricker, Noshene Ranjbar
       
  • Approach to Peripheral Neuropathy for the Primary Care Clinician
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): Christopher T. Doughty, Reza Seyedsadjadi Peripheral neuropathy is commonly encountered in the primary care setting and is associated with significant morbidity, including neuropathic pain, falls, and disability. The clinical presentation of neuropathy is diverse, with possible symptoms including weakness, sensory abnormalities, and autonomic dysfunction. Accordingly, the primary care clinician must be comfortable using the neurologic examination—including the assessment of motor function, multiple sensory modalities, and deep tendon reflexes—to recognize and characterize neuropathy. Although the causes of peripheral neuropathy are numerous and diverse, careful review of the medical and family history coupled with limited, select laboratory testing can often efficiently lead to an etiologic diagnosis. This review offers an approach for evaluating suspected neuropathy in the primary care setting. It will describe the most common causes, suggest an evidence-based workup to aid in diagnosis, and highlight recent evidence that allows for selection of symptomatic treatment of patients with neuropathy.
       
  • Strategies for the Prevention of Coronary Artery Disease Complications:
           Can We Do Better'
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): John A Ambrose, Amir Najafi Billions of dollars have been spent over the past 25 years on developing new therapies for the prevention/treatment of adverse cardiac events related to atherosclerotic cardiovascular disease. Although some therapies have been lifesaving, several mega-randomized studies have shown only a
       
  • 'A Man Walks Into a Bar': Riddles in the Teaching of Medicine
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): Evan T. Hall, Kathryn W. Weaver, Alexander C. Perino, Andrew Elder, Abraham Verghese
       
  • Twenty Children, Six Teachers, Two Sets of Eyes, a Dog, and a
           Transformation
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): Daniel G. Federman
       
  • A Reappraisal of the Lipid Hypothesis
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): Robert DuBroff
       
  • The Lifespan of Genetic Testing
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): Ersilia M. DeFilippis, Heidi Rehm, Allison L. Cirino, Neal K. Lakdawala
       
  • Diet Redux: Which Food Type Leads to Heart Attacks'
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): Joseph S. Alpert
       
  • Infection and Venous Thromboembolism: A Risk Assessment
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): Tomoyuki Kawada
       
  • Role of Paramedical Staff in a Health Service
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): Jagdeep Singh Gandhi
       
  • The Reply
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): Mary K. Rhee, Lawrence S. Phillips
       
  • Use of Inpatient Glucose Values in Identifying Patients at High Risk for
           Diabetes
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): Aidar R. Gosmanov
       
  • The Reply
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): Stuart R. Chipkin
       
  • Ten Most Important Things to Know About Caring for Transgender Patients
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): Jin Jun Luo
       
  • The Reply
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): Muthiah Vaduganathan, Manan Pareek, Arman Qamar, Ambarish Pandey, Michael H Olsen, Deepak L Bhatt
       
  • The Role of Physical Activity in the New 2017 American College of
           Cardiology/American Heart Association Blood Pressure Guidelines
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): Massimo Leggio, Elisa Caldarone, Mario Lombardi, Stefania D'Emidio, Paolo Severi, Maria Grazia Bendini, Andrea Mazza, Augusto Fusco
       
  • Hypokalemia in an End-Stage Renal Disease Patient
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): Ashish Verma, Muhammad Hassaan Shahid, Laura Youngblood
       
  • Unexpected Hydronephrosis: Mesenteric Fibromatosis
    • Abstract: Publication date: September 2018Source: The American Journal of Medicine, Volume 131, Issue 9Author(s): Ami Schattner, Monica Huszar, Meital Adi
       
  • Hall Pass
    • Abstract: Publication date: Available online 20 September 2018Source: The American Journal of MedicineAuthor(s): Dr. Gregory E. Brisson
       
  • Diagnostic and Management Dilemma: Massive Hemoptysis from Severe Mitral
           Stenosis
    • Abstract: Publication date: Available online 19 September 2018Source: The American Journal of MedicineAuthor(s): Jennifer Frampton, Timothy Beaver, Megan Coylewright
       
  • A Bad Sign: Dermatomyositis with Interstitial Lung Disease
    • Abstract: Publication date: Available online 19 September 2018Source: The American Journal of MedicineAuthor(s): Siriwan Palawisuth, Kornphaka Kantikosum, Mattana Patiyasikunt, Thitiwat Sriprasart, Pravit Asawanonda, Pawinee Rerknimitr
       
  • Bilateral Breast Ulcers: Granulomatosis with Polyangiitis
    • Abstract: Publication date: Available online 19 September 2018Source: The American Journal of MedicineAuthor(s): Pierre-André Jarrot, Marie-Laure Pelletier, Marion Brun, Martin Penicaud, Karin Mazodier, Audrey Benyamine, Jean Del Grande, Rodolphe Jean, Dominique Casanova, Gilles Kaplanski, Pierre-Jean Weiller
       
  • How Strongly do Physical Examination Estimates and Ultrasonographic
           Measurements of Liver Size Correlate' A Prospective Study
    • Abstract: Publication date: Available online 19 September 2018Source: The American Journal of MedicineAuthor(s): Justin Loloi, Ankit Patel, Patrick McDevitt, Michael A. Bruno, Thomas Riley BackgroundLiver size assessed by physical exam and ultrasound has long been used to gain useful clinical information. The size measurements obtained by these modalities have been difficult to compare as they are measured in two different axes (trans-axial versus mid-clavicular). Our objective is to identify a measurement correlation between ultrasound and physical exam liver size findings. We aim to develop a correction factor where by the liver size can be translated between the measured trans-axial size obtained by ultrasound and physical exam size when measured in the mid-clavicular line.MethodsWe conducted a prospective study including one hundred and one adult patients with liver disease undergoing liver biopsy between April 2008 and November 2008 at Penn State Health Milton S. Hershey Medical Center.Liver measurements were obtained by physical exam and ultrasound as performed by a single hepatologist.ResultsThe average physical exam size using the mid-clavicular approach was 8.9 cm +/- 1.13. On ultrasound, the average trans-axial measurement was 14.3 cm +/- 1.6. A ratio was made between measurements from the mid-clavicular line physical exam size and trans-axial ultrasound size, and found to have a mean correction factor of 1.6 +/- 0.14. The correction factor was applied to the physical exam-determined liver size and compared to ultrasound findings, with 76% of values (77/101) falling within 10% of the ultrasound-determined liver size.ConclusionThis study proves a strong correlation exists between physical examination estimates of liver size and the measured size on ultrasonogaphy. Multiplying the percussed liver span by a correction factor consistently yields accurate predictions of the transaxial liver span.
       
  • Spironolactone and Outcomes in Older Patients with Heart Failure and
           Reduced Ejection Fraction
    • Abstract: Publication date: Available online 19 September 2018Source: The American Journal of MedicineAuthor(s): Essraa Bayoumi, Phillip H. Lam, Daniel J. Dooley, Steven Singh, Charles Faselis, Charity J. Morgan, Samir Patel, Helen M. Sheriff, Selma F. Mohammed, Carlos E. Palant, Bertram Pitt, Gregg C. Fonarow, Ali AhmedBackgroundThe efficacy of mineralocorticoid receptor antagonists or aldosterone antagonists in heart failure with reduced ejection fraction (HFrEF) is well known. Less is known about their effectiveness in real-world older patients with HFrEF.MethodsOf the 8206 patients with HF and ejection fraction ≤35% without prior spironolactone use in the Medicare-linked OPTIMIZE-HF registry, 6986 were eligible for spironolactone therapy based on serum creatinine criteria (men ≤2.5 mg/dL, women ≤2.0 mg/dL) and 865 received a discharge prescription for spironolactone. Using propensity scores for spironolactone use, we assembled a matched cohort of 1724 (862 pairs) patients receiving and not receiving spironolactone, balanced on 58 baseline characteristics (Creatinine Cohort: mean age, 75 years, 42% women, 17% African American). We repeated the above process to assemble a secondary matched cohort of 1638 (819 pairs) patients with estimated glomerular filtration rate ≥30 mL/min/1.73 m2 (eGFR Cohort: mean age, 75 years, 42% women, 17% African American).ResultsIn the matched Creatinine Cohort, spironolactone-associated hazard ratios (95% confidence intervals) for all-cause mortality, heart failure readmission, and combined endpoint of heart failure readmission or all-cause mortality were 0.92 (0.81–1.03), 0.87 (0.77–0.99), and 0.87 (0.79–0.97), respectively. Respective hazard ratios (95% confidence intervals) in the matched eGFR Cohort were 0.87 (0.77–0.98), 0.92 (0.80–1.05) and 0.91 (0.82–1.02).ConclusionsThese findings provide evidence of consistent, albeit modest, clinical effectiveness of spironolactone in older patients with HFrEF regardless of renal eligibility criteria used. Additional strategies are needed to improve the effectiveness of aldosterone antagonists in clinical practice.
       
  • Sarcoidosis presenting as isolated anasarca and hypercalcemia
    • Abstract: Publication date: Available online 19 September 2018Source: The American Journal of MedicineAuthor(s): Perrin E. Romine, Keith D. Eaton, Kelly G. Paulson, Rouba Hadi, Douglas S. Paauw
       
  • Program Coordinator Professional Development: Definition, Perception of
           Importance, Motivating Factors and Barriers
    • Abstract: Publication date: Available online 18 September 2018Source: The American Journal of MedicineAuthor(s): Lauralee Dubois, Theresa Marsh, Lindsay B. DemersHighlightsA program coordinator's work and continued development have direct impact on:ØOverall training program operationsØSuccessful administration of the Clinical Competency CommitteeØSuccessful administration of the Program Evaluation CommitteeØSuccessful implementation of quality improvement initiativesØSuccessful monitoring of trainee progress through numerous evaluation methods including milestone tracking and reportingOversight of administrative processing of performance improvement plans and/or remediation plans for struggling learners
       
  • Marijuana's Effects on Brain Structure and Function: What Do We Know and
           What Should We Do' A Brief Review and Commentary
    • Abstract: Publication date: Available online 18 September 2018Source: The American Journal of MedicineAuthor(s): Richard D. deShazo, Sara B. Parker, Daniel Williams, John B. Ingram, Mahmoud Elsohly, Kathryn Rodenmeyer, Kyle McCullouch The recent Federal Drug Administration approval of the marijuana constituent cannabidiol (CBD) as safe and effective for treatment of two rare forms of epilepsy, has raised hopes that others of the 500 chemicals in marijuana will be found to be therapeutic. However, the long term consequences of street marijuana use are unclear and recent studies raise red flags about its effects. Changes in brain maturation and intellectual function including decreases in intelligence quotient have been noted in chronic users and appear permanent in early users in most but not all studies. These studies suggest that at a minimum, regular marijuana use should be discouraged in individuals under the age of 21.
       
  • Fixed-dose combination amlodipine/celecoxib (Consensi™) for
           hypertension and osteoarthritis
    • Abstract: Publication date: Available online 18 September 2018Source: The American Journal of MedicineAuthor(s): Steven M. Smith, Rhonda M. Cooper-DeHoff The U.S. Food and Drug Administration recently granted an approved indication for the first fixed-dose combination antihypertensive (amlodipine) and non-steroidal anti-inflammatory drug (celecoxib) for treatment of comorbid hypertension and osteoarthritis. This review summarizes available data on this combination product, to be marketed as Consensi™ (Kitov Pharmaceuticals, Ltd, Tel Aviv, Israel), and discusses its potential place in therapy.
       
  • Granulomatosis with polyangiitis presenting as hypophysitis
    • Abstract: Publication date: Available online 18 September 2018Source: The American Journal of MedicineAuthor(s): Janet N. Chu, Sarah Goglin, Sophie Patzek, Sam Brondfield
       
  • The Art of Nitpicking
    • Abstract: Publication date: Available online 18 September 2018Source: The American Journal of MedicineAuthor(s): Leonard J. Hoenig
       
  • Asking how our patients understand addiction
    • Abstract: Publication date: Available online 18 September 2018Source: The American Journal of MedicineAuthor(s): Helen E. Jack, Devin Oller, John Kelly, Jessica F. Magidson, Sarah E. Wakeman
       
  • Assessment and Treatment of Physician Speechlessness
    • Abstract: Publication date: Available online 18 September 2018Source: The American Journal of MedicineAuthor(s): Michael W. Kahn
       
  • The Computerized ECG: Friend and Foe
    • Abstract: Publication date: Available online 8 September 2018Source: The American Journal of MedicineAuthor(s): Harold Smulyan Computerized interpretation of the electrocardiogram (ECG) began in the 1950’s when conversion of its analog signal to digital form became available. Since then automatic computer interpretations of the ECG have become routine, even at the point of care, by the addition of interpretive algorithms to portable ECG carts. Now,>100 million computerized ECG interpretations are recorded yearly in the USA. These interpretations have contributed to medical care by reducing physician reading time and accurately interpreting most normal ECG's. But errors do occur. The computer cannot be held responsible for misinterpretations due to recording errors i.e. muscle artifacts or lead reversal. But in many abnormal ECGs, the computer makes its own errors - sometimes critical - in its incorrect detection of arrhythmias, pacemakers and myocardial infarctions. These errors require that all computerized statements be over read by trained physicians who have the advantage of clinical context, unavailable to the computer. Together, the computer and over readers now provide the most accurate ECG interpretations available.
       
  • Should Patients Infected with Borrelia burgdorferi No Longer Be Referred
           to as Having Lyme Disease'
    • Abstract: Publication date: Available online 8 September 2018Source: The American Journal of MedicineAuthor(s): Gary P. Wormser
       
  • DOUBLING OF HEMOGLOBIN A1C ON PCSK 9 INHIBITOR THERAPY
    • Abstract: Publication date: Available online 8 September 2018Source: The American Journal of MedicineAuthor(s): Raafia Memon, Rana Malek, Kashif M. Munir
       
  • The tradeoff of cancer drug regulatory policy: Faster approvals for one
           means less knowledge for another
    • Abstract: Publication date: Available online 7 September 2018Source: The American Journal of MedicineAuthor(s): Derrick Tao, Sally Schott, Vinay Prasad
       
  • Down the Rabbit Hole: Cutaneous Tuberculosis
    • Abstract: Publication date: Available online 7 September 2018Source: The American Journal of MedicineAuthor(s): Joshua S. Mervis, Brian C. Machler, Andrew J. Hanly, Daniel G. Federman
       
  • Lift Then Shift: Thyrotoxic Periodic Paralysis
    • Abstract: Publication date: Available online 7 September 2018Source: The American Journal of MedicineAuthor(s): Emily Silverman, Lawrence A. Haber, Rabih M. Geha
       
  • Novel and Emerging Therapeutics for Primary Prevention of Cardiovascular
           Disease
    • Abstract: Publication date: Available online 7 September 2018Source: The American Journal of MedicineAuthor(s): Leo F. Buckley, Salvatore Carbone, Ahmed Aldemerdash, Nayyra Fatani, John Fanikos Cardiovascular disease is responsible for 205 deaths per 100,000 persons annually and the leading cause of death worldwide. The public health burden of cardiovascular disease is expected to continue to grow as the prevalence of many cardiovascular risk factors increases. Several novel classes of glucose lowering, lipid lowering and weight loss therapeutics have shown mortality benefits in outcomes trials. However, a large proportion of subjects in those trials had established cardiovascular disease and, as a result, the role of these novel therapeutics in primary cardiovascular prevention is controversial. In this review, we highlight recent advances in the pharmacotherapeutic management of the cardiovascular risk factors of hyperglycemia, dyslipidemia and obesity. We examine key subgroups within recent cardiovascular outcome trials, weigh the risks and benefits of several novel therapeutics and provide practical insight into the use of these agents. Our article concludes with a look towards the future and provides the practitioner and scientist with an early view of emerging therapeutics that may play an important role in primary cardiovascular prevention.
       
  • Monitoring of apixaban in a super obese patient
    • Abstract: Publication date: Available online 7 September 2018Source: The American Journal of MedicineAuthor(s): Cornelia Fietz, Guido Michels, Carsten Müller, Martin H.J. Wiesen
       
  • Medicine in the artistry of Menzel
    • Abstract: Publication date: Available online 7 September 2018Source: The American Journal of MedicineAuthor(s): Jagdeep Singh Gandhi
       
  • Betrixaban: Safely Reducing Venous Thromboembolic Events with Extended
           Prophylaxis
    • Abstract: Publication date: Available online 7 September 2018Source: The American Journal of MedicineAuthor(s): Paul P. Dobesh, Brian J. Trevarrow Although venous thromboembolism prophylaxis of acute medically ill patients is commonly employed, a percentage of high-risk patients still have venous thromboembolic events within 30 days of discharge. Research over the last several years has attempted to identify characteristics of these high-risk patients to facilitate provision of extended prophylaxis and venous thromboembolic event reduction. However, extended prophylaxis has been associated with a significant increase in the risk for major bleeding until recently. Betrixaban, a new oral direct Xa-inhibitor with once daily dosing and limited renal elimination, significantly reduces risk of venous thromboembolism without increasing risk for major bleeding. Consequently, betrixaban is the only anticoagulant approved by the Food and Drug Administration for preventing venous thromboembolism with extended prophylaxis in acute medically ill patients.
       
  • The Case for Confirmation: Atrial Flutter
    • Abstract: Publication date: Available online 7 September 2018Source: The American Journal of MedicineAuthor(s): Tina Gupta, Chengyue Jin, Navya Gupta, Ezra A. Amsterdam, Matthew S Glassy
       
  • Keep an Eye on the Eye Symptoms of your Dialysis Patient
    • Abstract: Publication date: Available online 7 September 2018Source: The American Journal of MedicineAuthor(s): Eddy Jose Dejesus, Harini Bejjanki, Abhilash Koratala
       
 
 
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