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  Subjects -> MEDICAL SCIENCES (Total: 7902 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (198 journals)
    - ANAESTHESIOLOGY (111 journals)
    - CARDIOVASCULAR DISEASES (322 journals)
    - CHIROPRACTIC, HOMEOPATHY, OSTEOPATHY (21 journals)
    - COMMUNICABLE DISEASES, EPIDEMIOLOGY (212 journals)
    - DENTISTRY (270 journals)
    - DERMATOLOGY AND VENEREOLOGY (158 journals)
    - EMERGENCY AND INTENSIVE CRITICAL CARE (117 journals)
    - ENDOCRINOLOGY (146 journals)
    - FORENSIC SCIENCES (39 journals)
    - GASTROENTEROLOGY AND HEPATOLOGY (173 journals)
    - GERONTOLOGY AND GERIATRICS (130 journals)
    - HEMATOLOGY (146 journals)
    - HYPNOSIS (4 journals)
    - INTERNAL MEDICINE (155 journals)
    - LABORATORY AND EXPERIMENTAL MEDICINE (95 journals)
    - MEDICAL GENETICS (60 journals)
    - MEDICAL SCIENCES (2057 journals)
    - NURSES AND NURSING (329 journals)
    - OBSTETRICS AND GYNECOLOGY (195 journals)
    - ONCOLOGY (364 journals)
    - OPHTHALMOLOGY AND OPTOMETRY (128 journals)
    - ORTHOPEDICS AND TRAUMATOLOGY (160 journals)
    - OTORHINOLARYNGOLOGY (83 journals)
    - PATHOLOGY (100 journals)
    - PEDIATRICS (257 journals)
    - PHYSICAL MEDICINE AND REHABILITATION (148 journals)
    - PSYCHIATRY AND NEUROLOGY (784 journals)
    - RADIOLOGY AND NUCLEAR MEDICINE (187 journals)
    - RESPIRATORY DISEASES (97 journals)
    - RHEUMATOLOGY (67 journals)
    - SPORTS MEDICINE (74 journals)
    - SURGERY (374 journals)
    - UROLOGY, NEPHROLOGY AND ANDROLOGY (141 journals)

MEDICAL SCIENCES (2057 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: 42)
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: 5)
Acupuncture and Natural Medicine     Open Access  
Addiction Science & Clinical Practice     Open Access   (Followers: 8)
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: 26)
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: 7)
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: 3)
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: 14)
Advances in Virus Research     Full-text available via subscription   (Followers: 5)
Advances in Wound Care     Hybrid Journal   (Followers: 11)
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: 9)
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: 3)
Alpha Omegan     Full-text available via subscription  
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 3)
Althea Medical Journal     Open Access  
American Journal of Biomedical Engineering     Open Access   (Followers: 13)
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: 47)
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: 2)
Annals of Anatomy - Anatomischer Anzeiger     Hybrid Journal   (Followers: 2)
Annals of Bioanthropology     Open Access   (Followers: 4)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 17)
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 Health Research     Open Access  
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 Rehabilitation Medicine     Open Access  
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: 5)
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 Informatics     Hybrid Journal   (Followers: 2)
Applied Clinical Research, Clinical Trials and Regulatory Affairs     Hybrid Journal  
Applied Medical Informatics     Open Access   (Followers: 11)
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   (Followers: 1)
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: 14)
Arterial Hypertension     Open Access   (Followers: 1)
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 14)
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: 11)
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: 4)

        1 2 3 4 5 6 7 8 | Last

Journal Cover
American Journal of Medicine
Number of Followers: 47  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9343 - ISSN (Online) 1555-7162
Published by Elsevier Homepage  [3157 journals]
  • Giant cell arteritis presenting with a tongue lesion—diagnostic
           dilemma
    • Abstract: Publication date: Available online 16 January 2019Source: The American Journal of MedicineAuthor(s): George Cockey, Syed Raza Shah, Troy Hampton
       
  • ABC (Atrial fibrillation Better Care) pathway and healthcare costs in
           atrial fibrillation. The ATHERO-AF study
    • Abstract: Publication date: Available online 16 January 2019Source: The American Journal of MedicineAuthor(s): Daniele Pastori, Alessio Farcomeni, Pasquale Pignatelli, Francesco Violi, Gregory YH Lip BACKGROUNDThe Atrial fibrillation Better Care (ABC) pathway for the integrated approach to the management of patients with atrial fibrillation has been proposed to streamline patient management in an integrated, holistic manner, as follows: ‘A’ Avoid stroke with Anticoagulation; ‘B’ Better symptom management, with rate or rhythm control; ‘C’ Cardiovascular risk and comorbidity management, including lifestyle factors. ABC pathway compliance has been associated with a reduced rate of cardiovascular events compared to non-ABC compliant patients. However, the impact of the ABC pathway on health-related costs has not been evaluated.METHODSWe performed an exploratory analysis of costs related to cardiovascular events in the ATHERO-AF study, which is a prospective single-center cohort study including atrial fibrillation patients treated with vitamin K antagonists. A Diagnosis-Related Group code provided by the Italian Ministry of Health was assigned to each cardiovascular event by event typology to estimate the relative cost. The analysis was performed by dividing patients according to ABC pathway components.RESULTSOverall, the 118 cardiovascular events in the cohort incurred a cost of 1,017,354 euros (1,149,610 USD). The mean total costs were 13,050 (14,747 USD) and 11,218 euros (12,676 USD) for a non-fatal cardiac event or ischaemic stroke, respectively. The highest costs were related to cardiac complications, followed by non-fatal ischaemic stroke and cardiovascular death. Based on the ABC pathway components, the cost-saving was 719 euros (813 USD) per patient-year for patients in group A vs non-A, 703 euros (794 USD) for B vs non-B, 480 euros (542 USD) for C vs non-C and 2776 euros (3,137 USD) for ABC vs non-ABC.The cost per cardiovascular event increased with the number of uncontrolled ABC components: 0-1: 507 euros (573 USD), raising to 965 euros (1,091 USD) for 2 components and to 3,431 euros (3,877 USD) for patients not having any of the three components of the ABC.CONCLUSIONSManagement of atrial fibrillation patients according to the ABC pathway was associated with significantly lower health-related costs. Application of the ABC pathway as a management strategy may help reduce healthcare costs related to cardiovascular events in this high-risk patient population.
       
  • The rheumatoid hands of Renoir
    • Abstract: Publication date: Available online 16 January 2019Source: The American Journal of MedicineAuthor(s): Jagdeep Singh Gandhi
       
  • Mass Screening for Atrial Fibrillation: The Hype, The Methods, The
           Application
    • Abstract: Publication date: Available online 16 January 2019Source: The American Journal of MedicineAuthor(s): James A. Reiffel
       
  • Clinical characteristics and etiologies of miliary nodules in the US; A
           single center study
    • Abstract: Publication date: Available online 16 January 2019Source: The American Journal of MedicineAuthor(s): Moiz Salahuddin, Siddharth Karanth, Daniel Ocazionez, Rosa M Estrada-Y-Martin, Sujith V. Cherian BackgroundMiliary nodules have been typically described as a radiological manifestation of disseminated tuberculosis. However, miliary nodules are known to occur in a wide variety of conditions. The primary objective of the study was to identify clinical characteristics and etiologies of miliary nodules within our institution.MethodsUsing ICD 9 and 10 codes, electronic medical records were used to retrospectively identify 53 patients who fulfilled criteria of miliary nodules over the last 10 years. Demographic and clinical data were extracted, of all the patients in this cross sectional study.ResultsThe diagnosis of tuberculosis was made in 15 (28.3%) patients, sarcoidosis in 12 (22.6%), silicosis in 7 (13.2%), extra-thoracic malignancy in 5 (9.4%) and histoplasmosis in 4 (7.6%) patients. 4 out of 9 HIV patients had histoplasmosis. There was 1 case each of hypersensitivity pneumonitis, Pneumocystis jiroveci pneumonia, Mycobacterium-avium complex,Epstein-Barr Virus pneumonia, Cryptococcosis, Aspergillosis and primary lung cancer. Sputum was positive for acid fast bacilli (AFB) in 4 cases (28%), and bronchoscopy had a 57% successful yield in miliary TB.ConclusionOur study is the largest single center data review evaluating the etiology of miliary nodules within the US; most of the data exists in case reports.
       
  • Pulse Pressure, Cardiovascular Events, and Intensive Blood Pressure
           Lowering in the Systolic Blood Pressure Intervention Trial (SPRINT)
    • Abstract: Publication date: Available online 16 January 2019Source: The American Journal of MedicineAuthor(s): Manan Pareek, Muthiah Vaduganathan, Tor Biering-Sørensen, Christina Byrne, Arman Qamar, Zaid Almarzooq, Ambarish Pandey, Michael Hecht Olsen, Deepak L. BhattABSTRACTBackgroundThe efficacy and tolerability of intensive blood pressure lowering may vary by pulse pressure (systolic minus diastolic blood pressure).MethodsSPRINT randomized 9,361 high-risk, non-diabetic adults ≥50 years with systolic blood pressure 130-180 mmHg to intensive or standard antihypertensive treatment. The primary efficacy endpoint was the composite of acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. The primary safety endpoint was composite serious adverse events. We examined the prognostic implications of baseline pulse pressure and the effects of intensive blood pressure lowering on clinical outcomes across the spectrum of pulse pressure values using restricted cubic splines.ResultsMean baseline pulse pressure was similar between the two study groups (intensive treatment 62±14 mmHg vs. standard treatment 62±14 mmHg; P=0.59). Except stroke, for which the association with pulse pressure was best defined as linear, pulse pressure displayed a non-linear U-shaped relationship with the risk of all tested clinical endpoints (P0.05). The benefit of intensive blood pressure management on mortality appeared greatest in patients with a pulse pressure∼60 mmHg (P=0.03 for interaction). Pulse pressure did not modify the effect of intensive blood pressure lowering for other clinical endpoints (P>0.05 for interaction).ConclusionIn a large randomized clinical trial of high-risk patients, risks and benefits of intensive blood pressure lowering did not appear to be modified by baseline pulse pressure. Selection of appropriate candidates for intensive blood pressure lowering should not be limited by this parameter.
       
  • Pulmonary Embolism in the Differential Diagnosis of Cardiovocal Syndrome
    • Abstract: Publication date: Available online 14 January 2019Source: The American Journal of MedicineAuthor(s): Oscar M.P. Jolobe
       
  • Cardiorespiratory Fitness in Healthy People: A Step Forward to Primary
           Cardiovascular Health Promotion
    • Abstract: Publication date: Available online 14 January 2019Source: The American Journal of MedicineAuthor(s): Massimo Leggio, Cristina Tiberti, Giorgio Limongelli, Andrea Mazza
       
  • The Reply
    • Abstract: Publication date: Available online 11 January 2019Source: The American Journal of MedicineAuthor(s): Andrew G. Alexander, Kenneth A. Ballou
       
  • The Reply
    • Abstract: Publication date: Available online 11 January 2019Source: The American Journal of MedicineAuthor(s): Prashant Rao, Adolph M. Hutter, Aaron L. Baggish
       
  • Non-Alcoholic Fatty Liver Disease and Disease Mongering
    • Abstract: Publication date: Available online 11 January 2019Source: The American Journal of MedicineAuthor(s): Alain Braillon
       
  • Curious Case of Transient Movement Disorder
    • Abstract: Publication date: Available online 9 January 2019Source: The American Journal of MedicineAuthor(s): Katie Newton Kennedy, Yunan Darien Wang
       
  • Where does the blame for high healthcare costs go' An empirical
           analysis of newspaper and journal articles criticizing healthcare costs
    • Abstract: Publication date: Available online 9 January 2019Source: The American Journal of MedicineAuthor(s): Alyson Haslam, Tyler Crain, Jennifer Gill, Diana Herrera-Perez, Vinay Prasad BackgroundPublic perception of whom to blame for healthcare costs varies. Whether there is a mismatch between the causes of rising healthcare costs and the blame attributed to potential culprits has emerged as a topic of debate. We sought to compare the allocation of blame for rising healthcare costs in lay media articles and academic literature with actual healthcare spending in the US.MethodsWe performed a cross-sectional systematic analysis of published lay media and academic articles. On April 10, 2018, 200 Pubmed (academic) and 200 Google News (lay media) articles were collected through searches using the terms “healthcare costs” and “health care costs.” Articles were included if they criticized high cost of healthcare in the US. We calculated descriptive statistics for area(s) of healthcare blamed for high costs, publication type, and primary author affiliation.ResultsPubMed articles named 47 potential drivers of high cost and Google News articles named 225. Among PubMed articles, environment, lifestyle, and medical problems (n=15/47; 32%) was the most commonly cited source of high cost of healthcare, followed by no group singled out (n=14/47; 30%), and drugs or devices (n=8/47; 17%). Among Google News articles, insurers (n=63/225; 28%) were most commonly cited as possible sources of high cost of healthcare, followed by no group singled out (n=46/225; 21%), and hospitals (n=37/225; 17%).ConclusionsAllocation of blame for high healthcare costs is not always in proportion with true healthcare spending and certain healthcare drivers are under and overrepresented by academic and lay media publications.
       
  • Adverse Childhood Events: A Potent Risk Factor of Cardiovascular Risk
           Factors Especially Among Young Adults
    • Abstract: Publication date: Available online 9 January 2019Source: The American Journal of MedicineAuthor(s): Catherine Kreatsoulas, Eric W Fleegler, Laura D Kubzansky, Catherine M McGorrian, SV SubramanianABSTRACTIntroductionWhile cardiovascular disease is the leading cause of death, its determinants include unhealthy behaviours and clinical risk factors and are recognised as the “actual causes” of death. Risk likely accumulates over the life course and adverse childhood experiences may increase the risk of “actual causes” of death. To determine the prevalence and test the association of adverse childhood experiences among unhealthy behaviours and risk factors as a primordial risk factor among young adults.MethodsData were extracted from the 2009&2011 Behavioural Risk Factor Surveillance System. Individuals 18-99 years provided complete information on adverse childhood experiences, health behaviours and risk factors. Adverse childhood experiences were categorized and evaluated as cumulative burden. Multivariable logistic models, including stratified analysis for young adults, tested the association of adverse childhood experiences burden with unhealthy behaviours and risk factors.ResultsAmong 45,482 study participants, 52% report one adverse childhood experiences and 25% report two adverse childhood experiences categories. Among total study population, 37% report violence/emotional abuse, 34% report neglect and 12% report sexual abuse. Even one adverse childhood experience is strongly associated with hypertension, dyslipidemia and diabetes, and while the association increases in a dose-response (p trend
       
  • Ten Secrets To A Long Life
    • Abstract: Publication date: Available online 9 January 2019Source: The American Journal of MedicineAuthor(s): William H. Frishman For centuries there has been an ongoing search to identify the secrets of long life and healthy ageing. Recently, multiple factors have been identified including genetics, the introduction of antibiotics, vaccines, and public health, effective management of cardiovascular risk factors, advances in surgery, eliminating or modifying high risk behaviors, family and social supports, eliminating wars and poverty, luck, exercise and nutrition, and psychological factors such as optimism and conscientiousness. To increase a maximum life span which is now estimated to be 115-120 years, will involve manipulation of genes and the body's stem cells and the potential use of senolytic drugs (that kill old cells) which will need to be investigated. This is a worthy pursuit, if these interventions will also maintain or enhance quality of life.
       
  • Demographic, Clinical, and Radiologic Characteristics of a Cohort of
           Patients with Takayasu Arteritis
    • Abstract: Publication date: Available online 4 January 2019Source: The American Journal of MedicineAuthor(s): Catalina Sanchez-Alvarez, Lester E. Mertz, Colleen S. Thomas, Jordan J. Cochuyt, Andy AbrilABSTRACTBackgroundTakayasu arteritis is a rare large-vessel vasculitis that predominantly affects females of Asian descent. This retrospective analysis was performed to increase understanding of the epidemiology of Takayasu Arteritis in the United States.MethodsWe performed a retrospective cohort study in 2 tertiary centers. Patients were selected according to the American College of Rheumatology classification criteria for Takayasu Arteritis. Data collected included demographic characteristics, physical examination, treatments, and surgical interventions. Data were managed with REDCap electronic data capture tools.ResultsThe study included 57 patients. The female:male ratio was 4.2:1, the median age at diagnosis was 29 years, 61.4% of the patients were white, and 86% of the patients had stenosis on imaging. Hata V was the most common angiographic classification (37.5% of patients). Vascular interventions were required in 43.9% of patients. The most frequent complications were hypertension (56.1%), renal artery stenosis (28.1%), and aortic insufficiency (19.3%).ConclusionsTakayasu Arteritiscontinues to be a rare large-vessel vasculitis. In the United States, it tends to affect predominantly white females, with cervicobrachial involvement. This cohort reflects the morbidity, multiple interventions, and complications experienced by patients with Takayasu.
       
  • IgA-proliferative glomerulonephritis with monoclonal immunoglobulin
           deposits
    • Abstract: Publication date: Available online 4 January 2019Source: The American Journal of MedicineAuthor(s): Taro Horino, Osamu Ichii, Yoshio Terada
       
  • Critical Illness Causing Marked Hyperlipasemia
    • Abstract: Publication date: Available online 3 January 2019Source: The American Journal of MedicineAuthor(s): Ernst Alvarez, Riaad Persaud, Jennie Soniega-Sherwood, Jamela Rattray, Mark Richman
       
  • Potential dangers of serum urate-lowering therapy
    • Abstract: Publication date: Available online 3 January 2019Source: The American Journal of MedicineAuthor(s): Maria Vanessa Perez-Gomez, Lorenz-Alexander Bartsch, Esmeralda Castillo-Rodriguez, Raul Fernandez-Prado, Mehmet Kanbay, Alberto Ortiz In observational studies, high serum urate levels are associated with adverse outcomes, including mortality. However, the hypothesis that urate lowering may improve non-gout outcomes has not been confirmed by placebo-controlled clinical trials. On the contrary, seven recent placebo-controlled trials of urate lowering drugs with different mechanisms of action (uricosuric: lesinurad; xanthine oxidase inhibition: febuxostat; uricase: pegloticase) have observed higher mortality or trends to higher mortality in gout patients with the largest decreases in serum urate. Since all urate-lowering mechanisms were implicated, this raises safety concerns about urate lowering itself. Far from unexpected, the higher mortality associated with more intense urate lowering is in line with the U-shaped association of urate with mortality in some observational studies. Urate accounts for most of the antioxidant capacity of plasma and strategies to increase urate are undergoing clinical trials in neurological disease. Post-hoc analysis of recent trials should explore whether the magnitude of urate lowering is associated with adverse outcomes, and safety trials are needed before guidelines recommend lowering serum urate below certain thresholds.
       
  • Diabetic Mastopathy Masquerading as Breast Cancer
    • Abstract: Publication date: Available online 3 January 2019Source: The American Journal of MedicineAuthor(s): Sonali Gupta, Pradeep Goyal, Soumya Thumma, Joseph Mattana
       
  • Diagnosis and Treatment of Peptic Ulcer Disease
    • Abstract: Publication date: Available online 3 January 2019Source: The American Journal of MedicineAuthor(s): Robert T. Kavitt, Anna M. Lipowska, Adjoa Anyane-Yeboa, Ian M. GralnekABSTRACTPeptic ulcer disease continues to be a source of significant morbidity and mortality worldwide. Approximately two-thirds of patients found to have peptic ulcer disease are asymptomatic. In symptomatic patients, the most common presenting symptom of peptic ulcer disease is epigastric pain, which may be associated with dyspepsia, bloating, abdominal fullness, nausea, and/or early satiety. Most cases of peptic ulcer disease are associated with H. pylori infection and/or the use of non-steroidal anti-inflammatory drugs (NSAIDs). In this review, we discuss the role of proton pump inhibitors (PPIs) in the management of peptic ulcer disease, highlight the latest guidelines regarding the diagnosis and management of H. pylori, and discuss the latest evidence in the management of complications related to peptic ulcer disease including endoscopic intervention for peptic ulcer-related bleeding. Timely diagnosis and treatment of peptic ulcer disease and its sequelae are crucial in order to minimize associated morbidity and mortality, as is prevention of peptic ulcer disease among patients at high risk including those infected with H. pylori and users of NSAIDs.
       
  • Vaccination in the adult patient infected with HIV: a review of vaccine
           efficacy and immunogenicity
    • Abstract: Publication date: Available online 3 January 2019Source: The American Journal of MedicineAuthor(s): Firas El Chaer, Hana M. El Sahly HIV-infected patients remain at increased risk of mortality and morbidity from vaccine-preventable diseases partly due to the persisting immunopathology which results in impaired responses to vaccination despite virologic suppression. As data on clinical effectiveness in immunocompromised patients remains limited, under-vaccination of HIV-infected individuals poses a major concern. Multiple societies have published recommendations on vaccination in HIV-infected individuals, and many of which are based on extrapolation of data from clinical trials that usually exclude HIV infected patients; although there is a growing body of data from HIV infected patients as well. In this review we describe the available literature on vaccine response in the adult HIV-infected patient as measured by immunogenicity and/or vaccine efficacy.
       
  • Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA)
    • Abstract: Publication date: Available online 30 December 2018Source: The American Journal of MedicineAuthor(s): Joseph S. Alpert, Rokas Serpytis, Pranas Serpytis, Qin M. Chen
       
  • The Electronic Medical Record: Beauty and the Beast
    • Abstract: Publication date: Available online 30 December 2018Source: The American Journal of MedicineAuthor(s): Joseph S. Alpert
       
  • Building Leadership Capacity for Mission Execution in a Large Academic
           Department of Medicine
    • Abstract: Publication date: Available online 24 December 2018Source: The American Journal of MedicineAuthor(s): Sherita Hill Golden, Eric Bass, Stephen Berry, Lee Daugherty Biddison, Danelle Cayea, Deidra Crews, Sanjay Desai, Khalil G. Ghanem, Carrie Herzke, Gregory Kirk, Flora Kisuule, Rachel Levine, Kieren Marr, Brian O'Rourke, Pankaj Pasricha, Kimberly Peairs, Stuart Ray, Samuel C. Durso, David Hellmann, Mark E. Anderson
       
  • The Case for Confirmation: Atrial Flutter
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Tina Gupta, Chengyue Jin, Navya Gupta, Ezra A. Amsterdam, Matthew S. Glassy
       
  • The Physician's Prayer
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Ankoor A. Talwar
       
  • Corticosteroids in the Management of Severe Coccidioidomycosis
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(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.MethodsWe present a case report of 2 patients with persistent and progressive coccidioidomycosis who demonstrated a dramatic response to adjunctive corticosteroid therapy.ResultsBoth patients had Coccidioides immitis cultured from respiratory samples. One was a 69-year-old man who had been treated with combination fluconazole and liposomal amphotericin for over 6 weeks, with persistent fever and pneumonia. The other was a 61-year-old man treated with fluconazole and then amphotericin for 3 weeks, with progression to acute respiratory distress syndrome and shock. Both received short courses of intravenous methylprednisolone and recovered to be discharged home.ConclusionsAs 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.
       
  • The Reply
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Hassan Khan, Jari A. Laukkanen
       
  • Sleep Duration and Mortality
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Tomoyuki Kawada
       
  • The Reply
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Todd C. Lee, Rodrigo B. Cavalcanti, Emily G. McDonald, James M. Brophy
       
  • How Do We Analyze Effects of Low Diastolic Blood Pressure'
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Mats Julius Stensrud, Susanne Strohmaier
       
  • Granulomatosis with Polyangiitis Presenting as Hypophysitis
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Janet N. Chu, Sarah Goglin, Sophie Patzek, Sam Brondfield
       
  • Diagnostic and Management Dilemma: Massive Hemoptysis from Severe Mitral
           Stenosis
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Jennifer Frampton, Timothy Beaver, Megan Coylewright
       
  • Doubling of Hemoglobin A1c on PCSK9 Inhibitor Therapy
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Raafia Memon, Rana Malek, Kashif M. Munir
       
  • Monitoring of Apixaban in a Super Obese Patient
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Cornelia Fietz, Guido Michels, Carsten Müller, Martin H.J. Wiesen
       
  • Sarcoidosis Presenting as Isolated Anasarca and Hypercalcemia
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Perrin E. Romine, Keith D. Eaton, Kelly G. Paulson, Rouba Hadi, Douglas S. Paauw
       
  • Ruptured Urinary Bladder After a ‘Simple’ Fall
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Ami Schattner, Ina Dubin, Yair Glick
       
  • Keep an Eye on the Eye Symptoms of Your Dialysis Patient
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Eddy Jose Dejesus, Harini Bejjanki, Abhilash Koratala
       
  • Prevalence, Determinants, and Clinical Associations of High-Sensitivity
           Cardiac Troponin in Patients Attending Emergency Departments
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Kuan Ken Lee, Ala Noaman, Amar Vaswani, Matthew Gibbins, Megan Griffiths, Andrew R. Chapman, Fiona Strachan, Atul Anand, David A. McAllister, David E. Newby, Alasdair J. Gray, Nicholas L. Mills, Anoop S.V. Shah BackgroundHigh-sensitivity cardiac troponin assays may improve the diagnosis of myocardial infarction but increase the detection of elevated cardiac troponin in patients without acute coronary syndrome.MethodsIn a prospective cohort study, we evaluated the prevalence, determinants, and outcome of patients with elevated cardiac troponin attending the emergency department without suspected acute coronary syndrome. We measured high-sensitivity cardiac troponin in 918 consecutive patients attending the emergency department without suspected acute coronary syndrome who had blood sampling performed by the attending clinician. Elevated high-sensitivity cardiac troponin I was defined as concentrations above the sex-specific 99th percentile threshold. Clinical demographics, physiological measures, and all-cause mortality at 1 year associated with elevated high-sensitivity cardiac troponin concentrations were recorded.ResultsElevated cardiac troponin concentration occurred in 114 (12.4%) patients, of whom 2 (0.2%), 3 (0.3%), and 109 (11.9%) were adjudicated as type 1 myocardial infarction, type 2 myocardial infarction, and myocardial injury, respectively. Elevated troponin concentrations were associated with increasing age, worsening renal function, multimorbidity, and adverse physiology. Across a total of 912 patient-years follow-up, cardiac troponin concentration was a strong predictor of death (hazard ratio [HR] 1.26 per 2-fold increase, 95% confidence interval [CI] 1.06 to 1.49) independent of age, sex, multimorbidity, and adverse physiology.ConclusionsHigh-sensitivity cardiac troponin concentrations were elevated in 1 in 8 consecutive patients without suspected acute coronary syndrome attending the emergency department and were associated with increasing age, multimorbidity, adverse physiology, and death. Elevated cardiac troponin in unselected patients predominantly reflects myocardial injury rather than myocardial infarction.
       
  • Quite a Stretch: Internal Oblique Muscle Hematoma
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Wen-Shan Chiu, Yu-Jang Su, Chih-Chun Huang
       
  • Lift Then Shift: Thyrotoxic Periodic Paralysis
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Emily Silverman, Lawrence A. Haber, Rabih M. Geha
       
  • Recertification: A Tale of Good Intentions but Lots of Strife
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): James J. Glazier, Amir Kaki
       
  • How Strongly Do Physical Examination Estimates and Ultrasonographic
           Measurements of Liver Size Correlate' A Prospective Study
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Justin Loloi, Ankit Patel, Patrick McDevitt, Michael A. Bruno, Thomas Riley BackgroundLiver size assessed by physical examination 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 2 different axes (transaxial vs midclavicular). Our objective was to identify a measurement correlation between ultrasound and physical examination liver size findings. We aimed to develop a correction factor whereby the liver size could be translated between the measured transaxial size obtained by ultrasound and physical examination size when measured in the midclavicular line.MethodsWe conducted a prospective study including 101 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 examination and ultrasound, which were performed by a single hepatologist.ResultsThe average physical examination size using the midclavicular approach was 8.9 cm ± 1.13. On ultrasound, the average transaxial measurement was 14.3 cm ± 1.6. A ratio was made between measurements from the midclavicular line physical examination size and transaxial ultrasound size, and found to have a mean correction factor of 1.6 ± 0.14. The correction factor was applied to the physical examination-determined liver size and compared with ultrasound findings, with 76% of values (77/101) falling within 10% of the ultrasound-determined liver size.ConclusionThis study proves that a strong correlation exists between physical examination estimates of liver size and the measured size on ultrasonography. Multiplying the percussed liver span by a correction factor consistently yields accurate predictions of the transaxial liver span.
       
  • Impact of Geriatrician-Performed Comprehensive Geriatric Care on
           Medication Use and Cognitive Function in Older Adults Referred to a
           Non-Hospital-Based Rehabilitation Unit
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Dmitri Zintchouk, Merete Gregersen, Torsten Lauritzen, Else Marie Damsgaard Background and PurposeEighty-eight percent of older adults referred to Danish non-hospital-based rehabilitation units used ≥5 regular drugs per day at the beginning of rehabilitation. The aim of the study was to explore whether geriatrician-performed comprehensive geriatric care had an impact on medication use and cognitive function in older adults after a 90-day follow-up.MethodsThere were 368 individuals aged ≥65 years recruited from 2 Danish non-hospital-based rehabilitation units and randomized to geriatric care (the intervention group) or usual care (the control group). The medication adjustment was the key element of the geriatric intervention. The control group received standard rehabilitation with general practitioners as back-up. The outcomes were prevalence of hyperpolypharmacy (≥10 regular medications prescribed concurrently), the change in medication profile, and cognitive function measured using the Mini-Mental State Examination.ResultsIn the intervention group, fewer persons were exposed to hyperpolypharmacy (odds ratio 0.5; 95% confidence interval, 0.3-0.9) compared with the control group after 90 days. The prevalence of use of proton pump inhibitors, loop diuretics, or antiasthmatic inhalers was lower, while the prevalence of cholecalciferol use was higher in the intervention group compared with the control group. The prevalence of other drug use and cognitive function between groups were not different.ConclusionsGeriatrician-performed comprehensive geriatric care may reduce the prevalence of hyperpolypharmacy and optimize the medication profile in older adults referred to a non-hospital-based rehabilitation. No impact on cognitive function was found.
       
  • Prevalence, Echocardiographic Correlations, and Clinical Outcome of
           Tricuspid Regurgitation in Patients with Significant Left Ventricular
           Dysfunction
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Shirit Sara Kazum, Alexander Sagie, Tzippy Shochat, Tuvia Ben-Gal, Tamir Bental, Ran Kornowski, Yaron Shapira, Mordehay Vaturi, Tal Hasin PurposeWe initiated this study to evaluate the prevalence and clinical significance of tricuspid regurgitation in patients with left ventricular dysfunction.MethodsA single-center analysis of all echocardiographic studies between 2000 and 2013 was performed. Patients with ejection fraction
       
  • Spironolactone and Outcomes in Older Patients with Heart Failure and
           Reduced Ejection Fraction
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(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 Ahmed BackgroundThe 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 heart failure 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 (eGFR) ≥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.
       
  • A Young Man with a Mass: Non-Early Precursor T-Cell Lymphoblastic Lymphoma
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Yang Jiang, Abhishek Maiti, Zeyad Kanaan
       
  • Program Coordinator Professional Development: Definition, Perception of
           Importance, Motivating Factors, and Barriers
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(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
       
  • Down the Rabbit Hole: Cutaneous Tuberculosis
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Joshua S. Mervis, Brian C. Machler, Andrew J. Hanly, Daniel G. Federman
       
  • A Missing Link: Sarcoid-Lymphoma Syndrome
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Anand Kumthekar, Philipp W. Raess, Daniela Ghetie
       
  • Applying the 'COST' (Culture, Oversight, Systems Change, and Training)
           Framework to De-Adopt the Neutropenic Diet
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Arjun Gupta, Timothy J. Brown, Shruti Singh, Ahana Sen, Deepak Agrawal, Hsiao C. Li, Christopher Moriates, David H. Johnson, Navid Sadeghi
       
  • Motor Neuron Disease: Pathophysiology, Diagnosis, and Management
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Laura A. Foster, Mohammad Kian Salajegheh Patients with motor neuron diseases may present to primary care clinic or may be initially encountered in the inpatient setting. Timely diagnosis of these conditions is a key factor in early intervention and therapy, and accuracy of diagnosis is of extreme importance, in particular for amyotrophic lateral sclerosis with its poor prognosis. The aim of this review article is to provide a clinical and diagnostic framework for the diagnosis and evaluation of motor neuron disease for primary care physicians.
       
  • Misconceptions and Facts About Takotsubo Syndrome
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Mario Rodríguez, Wojciech Rzechorzek, Eyal Herzog, Thomas F. Lüscher Takotsubo syndrome, initially described in the 1990s by Sato, has been increasingly recognized around the world. Pathophysiology is directed towards central role of catecholamine surge , but other aspects like microvascular endothelial dysfunction and vasospasm have also been described. Dyspnea and chest pain are most common manifestations, but syncope can also be seen. Right ventricular involvement is not uncommon, and left ventricular outflow tract obstruction is a frequent complication. EKG can differentiate between Takotsubo syndrome and myocardial infarction, but coronary angiography should always be performed. Although treatment has been angiotensin converting enzyme inhibitors and betablockers, recent evidence from nonrandomized studies shows no benefit on betablockers regarding outcomes.
       
  • Novel and Emerging Therapeutics for Primary Prevention of Cardiovascular
           Disease
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(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 is 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, so, 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 toward 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.
       
  • Applying Evidence-Based Medicine to Shared Decision Making: Value of
           Restricted MeanSurvival Time
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Zachary R. McCaw, Ariela R. Orkaby, Lee-Jen Wei, Dae Hyun Kim, Michael W. Rich
       
  • Should Patients Infected with Borrelia burgdorferi No Longer Be Referred
           to as Having Lyme Disease'
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Gary P. Wormser
       
  • Medical Tourists: Incoming and Outgoing
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): James E. Dalen, Joseph S. Alpert
       
  • Are We Ready to Practice Lifestyle Medicine'
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): James M. Rippe
       
  • A Tale of Two Cities: Persistently High Homicide Rates in Baltimore City
           Compared With Significant Declines in New York City
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Robert S. Levine, Rebecca P. Schneid, Roger J. Zoorob, Charles H. Hennekens
       
  • The Racial Divide Here at Home
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Joseph S. Alpert
       
  • Medicine in the Artistry of Menzel
    • Abstract: Publication date: January 2019Source: The American Journal of Medicine, Volume 132, Issue 1Author(s): Jagdeep Singh Gandhi
       
  • Association of Hospital Employee Satisfaction with Patient Safety and
           Satisfaction within Veterans Affairs Medical Centers
    • Abstract: Publication date: Available online 20 December 2018Source: The American Journal of MedicineAuthor(s): Ravinder Kang, Samuel T. Kunkel, Jesse A. Columbo, Philip P. Goodney, Sandra L. Wong BackgroundEmployee satisfaction is thought to impact performance. However, which aspects of employee satisfaction matter most is unknown. We utilized data from the Veterans Affairs Medical Centers (VAMC) via their Strategic Analytics for Improvement and Learning (SAIL) program to examine the association between organizational satisfaction as well as job-specific satisfaction with measures of patient safety, patient satisfaction and hospital rating.MethodsThe correlation between employee satisfaction with their organization and with their specific job were examined across indicators of patient care using Pearson and Spearman's correlation. Employee satisfaction data were obtained from the All Employee Survey.ResultsWe found that employee job-specific satisfaction does not correlate with patient outcomes while higher satisfaction with the organization is associated with improved patient safety (rho= -0.19, p
       
  • Medical Correlates of Chronic Multisymptom Illness in Gulf War Veterans
    • Abstract: Publication date: Available online 18 December 2018Source: The American Journal of MedicineAuthor(s): Melvin Blanchard, Hector D. Molina-Vicenty, Phyllis K. Stein, Xue Li, Joel Karlinsky, Renee Alpern, Domenic J. Reda, Rosemary ToomeyABSTRACTBackgroundChronic multisymptom illness is more prevalent among deployed than non-deployed Gulf War 1 veterans. Objective physiologic markers of chronic multisymptom illness are lacking. The purpose of this study is to determine whether measurable abnormalities in the autonomic nervous system or hypothalamic-pituitary adrenal axis would distinguish chronic multisymptom illness cases (CMI+) from controls (CMI-) among deployed veterans of the 1990-1991 Gulf War.MethodsThis is a cross-sectional case-control cohort study that examined deployed veterans who participated in the Phase III study: National Health Survey of Gulf War Veterans and Their Families. Autonomic nervous system and hypothalamic-pituitary adrenal axis function-related measures included: 24-hour heart rate variability, urinary catecholamines and cortisol, hypertension, insulin sensitivity, dyslipidemia, body fat, bone mineral density, and ultrasensitive C-reactive protein.ResultsGulf War 1 veterans with chronic multisymptom illness (n = 73) and without the condition (n = 111) were studied. Sociodemographic characteristics were similar. Veterans with chronic multisymptom illness reported poorer mental and physical functioning, greater use of prescription medications and more non-routine clinic visits. These veterans were also more likely to have fibromyalgia syndrome, irritable bowel syndrome, metabolic syndrome, and among males, a larger waist-to-hip ratio. Lower values for a non-linear heart-rate-variability parameter—the short-term fractal scaling exponent (DFA1), reflecting an increased randomness of beat-to-beat changes in heart rate—were observed in CMI+ compared with CMI- veterans (1.28±0.16 vs 1.35±0.15; p=0.005). Hypothalamic-pituitary-adrenal axis function measures were similar between groups.ConclusionIn this cohort of deployed Gulf War 1 veterans, we identified abnormal heart rate variability in veterans with chronic multisymptom illness compared to veterans without the condition, which suggests abnormal functioning of the autonomic nervous system and possible long-term cardiovascular effects.
       
  • Building Trust in the Profession: What can we learn from Choosing
           Wisely'
    • Abstract: Publication date: Available online 18 December 2018Source: The American Journal of MedicineAuthor(s): Richard J. Baron, Daniel B. Wolfson
       
  • Challenging to Treat: Fluctuating Abdominal and Joint Pain and Rash
    • Abstract: Publication date: Available online 18 December 2018Source: The American Journal of MedicineAuthor(s): Katherine L. Allen, Eric J. Dein, Osama M.E. Ali, Allan C. Gelber
       
  • Pruritic plaque on the arm after treatment for neurosyphilis
    • Abstract: Publication date: Available online 18 December 2018Source: The American Journal of MedicineAuthor(s): Erika Sawka, Erin Foster, Teri M. Greiling
       
  • The Importance of Being Curious
    • Abstract: Publication date: Available online 18 December 2018Source: The American Journal of MedicineAuthor(s): Eli Y. Adashi, Abdul-Kareem H. Ahmed, Philip A. Gruppuso
       
  • Clinical features and prognosis of patients with acute and chronic
           myocardial injury admitted to the emergency department
    • Abstract: Publication date: Available online 17 December 2018Source: The American Journal of MedicineAuthor(s): Alfredo Bardají, Gil Bonet, Anna Carrasquer, Maribel Gonzalez-del Hoyo, Karla Vasquez-Nuñez, Samuel Ali, Carme Boqué, German Cediel BackgroundThis study aimed to investigate the clinical features and prognosis of acute and chronic myocardial injury without clinical evidence of myocardial infarction in patients admitted to the emergency department.MethodsWe analysed the clinical data of all consecutive patients admitted to the emergency department during the years 2012 and 2013 who had at least two determinations of troponin I (TnI Ultra Siemens, Advia Centaur) and without a diagnosis of myocardial infarction. Clinical events were evaluated in a 3-year follow-up.ResultsA total of 1201 patients met the study's inclusion criteria and were included in the analysis (833 with cTnI below the 99th percentile, 261 with acute myocardial injury and 107 with chronic myocardial injury). During a median follow-up equal to a more than 36 months, mortality and rehospitalisation for heart failure were significantly higher in patients with acute or chronic myocardial injury with respect to patients without myocardial injury. No differences were observed in overall mortality between patients with acute and chronic myocardial injury, or in the rate of readmission due to acute coronary syndrome. However, the risk of readmission due to heart failure (adjusted HR 2.17, 95%CI: 1.26-3.75, p=0.005) was higher in patients with chronic myocardial injury.ConclusionsMortality in the long-term follow-up is high and similar in acute and chronic myocardial injury; however, the risk of readmission due to heart failure is higher in patients with chronic myocardial injury compared to patients with acute myocardial injury.
       
  • Clinical Outcomes After Treatment of Cocaine Induced Chest Pain with Beta
           Blockers: A Systematic Review and Meta-Analysis
    • Abstract: Publication date: Available online 16 December 2018Source: The American Journal of MedicineAuthor(s): Kevin Bryan Lo, Hafeez Ul Hassan Virk, Vladimir Lakhter, Pradhum Ram, Carlos Gongora, Gregg Pressman, Vincent Figueredo BackgroundRecent guidelines have suggested avoiding beta blockers in the setting of cocaine associated acute coronary syndrome. However, the available evidence is both scarce and conflicted. The purpose of this systematic review and meta-analysis is to investigate the evidence pertaining to the use of beta blockers in the setting of acute cocaine related chest pain, and its implication on clinical outcomes.MethodsElectronic databases were systematically searched to identify literature relevant to patients with cocaine associated chest pain who were treated with or without beta blockers. We examined the end-points of in-hospital all-cause mortality and myocardial infarction. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effects model.ResultsFive studies with a total of 1,447 patients were included. Our analyses found no differences between patients treated with or without beta blockers for either myocardial infarction (RR 1.08, 95% CI 0.61-1.91) or all-cause mortality (RR 0.75, 95% CI 0.46-1.24). Heterogeneity among included studies was low to moderate.ConclusionThis systematic review and meta-analysis suggests that beta blocker use is not associated with adverse clinical outcomes in patients presenting with acute chest pain related to cocaine use.
       
  • Evaluation of Prospectively Followed Adult Patients with Erythema Migrans
           Using the Beck Depression Inventory Second Edition
    • Abstract: Publication date: Available online 16 December 2018Source: The American Journal of MedicineAuthor(s): Gary P. Wormser, Kitae Park, Colby Madison, Julia Rozenberg, Donna McKenna, Carol Scavarda, Carol Karmen, Rhea Dornbush, Paul Visintainer BackgroundThe Beck Depression Inventory (BDI-II) may be used to evaluate individuals for symptoms of depression.MethodsIn a 1-year prospective study, 52 adult Lyme disease patients with erythema migrans and 104 matched control subjects were clinically assessed and completed the BDI-II at study entry and approximately 6 and 12 months later following antibiotic treatment.ResultsThe mean BDI-II score was significantly higher at the baseline visit among Lyme disease patients compared with controls (p=0.002), but no significant differences between the groups were observed at either the 6 or 12 month study visits. Over the course of the study, the mean BDI-II scores declined an average of approximately 0.22 points per month (p
       
  • TUSARC PROGNOSTIC: Prognostic value of high sensitivity troponin T assay
           in asymptomatic high cardiovascular risk patients
    • Abstract: Publication date: Available online 15 December 2018Source: The American Journal of MedicineAuthor(s): Diego Martín Raymondi, Héctor Garcia, Isabel Álvarez, Luis Hernández, Jorge Palazuelos Molinero, Vicente VillamandosABSTRACTObjectivesPrognostic value of high-sensitivity cardiac troponin T assays (hs-cTnT) have been carried out on selected populations in different studies and in registries of low cardiovascular risk general population. The aim of this study is to determine the prognostic value of hs-cTnT in a Spanish asymptomatic very high cardiovascular risk population.MethodFrom previously prospective cohort of TUSARC (troponina T UltraSensible en pacientes Asintomáticos de alto Riesgo Cardiovascular) registry, follow up was done in 602 patients (93,18%). The association of high hs-cTnT (≥99th percentile value) and incident of primary event was studied. Primary event was defined as combined mayor cardiovascular event (incident of cardiovascular death, decompensated heart failure, non-fatal cerebrovascular event, non-fatal myocardial infarction or coronary revascularization). Association of high hs-cTnT and incident or secondary events was studied as well.Resultsin patients with elevated high hs-cTnT, the incidence of primary event during follow up was significantly higher (18,3% vs 3,67% p< 0,001), as it was the incidence of heart failure (6,25 vs 0,73 p
       
  • Physician Compensation Methodology Must Change!
    • Abstract: Publication date: Available online 15 December 2018Source: The American Journal of MedicineAuthor(s): Morey Menacker
       
  • Beyond Burnout: A Physician Wellness Hierarchy Designed to Prioritize
           Interventions at the Systems Level
    • Abstract: Publication date: Available online 13 December 2018Source: The American Journal of MedicineAuthor(s): Daniel E. Shapiro, Cathy Duquette, Lisa M. Abbott, Timothy Babineau, Amanda Pearl, Paul Haidet Burnout has been implicated in higher physician turnover, reduced patient satisfaction, and worsened safety, but understanding the degree of burnout in a given physician or team does not direct leaders to solutions. The model proposed integrates a long list of variables that may ameliorate burnout into a prioritized, easy-to-understand hierarchy. Modified from Maslow's hierarchy, the model directs leaders to address physician's basic physical and mental health needs first; patient and physician physical safety second; and then address higher order needs including respect from colleagues, patients, processes, and the Electronic Health Record; appreciation and connection; and finally, time and resources to heal patients and contribute to the greater good. Assessments based on this model will help leaders prioritize interventions and improve physician wellness.
       
  • Burn Bright I: Reflections on the Burnout Epidemic (Part one of a two-part
           series)
    • Abstract: Publication date: Available online 11 December 2018Source: The American Journal of MedicineAuthor(s): Noshene Ranjbar, Mari Ricker
       
  • Plecanatide for Treatment of Chronic Constipation and Irritable Bowel
           Syndrome
    • Abstract: Publication date: Available online 11 December 2018Source: The American Journal of MedicineAuthor(s): Bryan L. LoveABSTRACTChronic idiopathic constipation and irritable bowel syndrome with constipation are commonly encountered in ambulatory patients, but limited options exist for patients with persistent or severe symptoms following treatment with non-prescription products. Plecanatide (Trulance, Synergy Pharmaceuticals) is a 16-amino acid peptide analogue of uroguanylin that stimulates guanylate cyclase-C receptors to increase chloride and bicarbonate secretion into the intestine and prevents the absorption of sodium ions, thereby increasing the secretion of water into the lumen. The influx of additional fluid accelerates intestinal transit, softens the stool and facilitates easier defecation. Plecanatide is the second guanylate cyclase-C receptor agonist to be approved by the US Food and Drug Administration for chronic idiopathic constipation and irritable bowel syndrome, but plecanatide is unique since its effects are limited to the proximal small bowel.
       
  • The ego has landed! What can be done about research misconduct, scandals
           and spins'
    • Abstract: Publication date: Available online 11 December 2018Source: The American Journal of MedicineAuthor(s): David R. Thompson, Alexander M. Clark
       
  • Significance of Obstetrical History with Future Cardiovascular Disease
           Risk
    • Abstract: Publication date: Available online 11 December 2018Source: The American Journal of MedicineAuthor(s): Emmanuel Bassily, Cameron Bell, Sean Verma, Nidhi Patel, Aarti Patel The maternal cardiovascular system undergoes profound changes to support the increasing demands of fetal growth during pregnancy. An accumulating body of evidence has shown that common pregnancy complications, including gestational diabetes mellitus, preeclampsia, low birth weight, and preterm delivery, can be associated with future cardiovascular adverse events in mothers. Factors such as glucose metabolism, hyperlipidemia, inflammatory markers, large and small vessel stiffness/functionality have been linked with these pregnancy conditions. Critically, there are no established guidelines to account for these maternal factors when considering future cardiovascular disease risk, one of the leading causes of female mortality. This paper reviews the study of cardiovascular disease and pregnancy, and proposes possible connections that should spur future investigation in an area of medicine that requires significant research.
       
  • At The Knees: Inguinoscrotal Hernia
    • Abstract: Publication date: Available online 11 December 2018Source: The American Journal of MedicineAuthor(s): Kristopher Ahn, Rukma Govindu
       
  • So, You Have to Give a Lecture—Are You Anxious'
    • Abstract: Publication date: Available online 5 December 2018Source: The American Journal of MedicineAuthor(s): Joseph S. Alpert
       
  • HYPONATREMIA: AN UNUSUAL LINK TO A COMMON ENCOUNTER
    • Abstract: Publication date: Available online 4 December 2018Source: The American Journal of MedicineAuthor(s): Raymond KH GOH, Brenda CHIANG, Marvin JW CHUA, Chaw Su NAING
       
  • Peri-Procedural Antithrombotic Management from a Patient Perspective: A
           Qualitative Analysis
    • Abstract: Publication date: Available online 3 December 2018Source: The American Journal of MedicineAuthor(s): Jennifer Acosta, Christopher Graves, Elizabeth Spranger, Jacob Kurlander, Anne E. Sales, Geoffrey D Barnes BackgroundPeri-procedural antithrombotic medication management is a complex, often confusing process for patients and their providers. Communication difficulties often lead to suboptimal medication management resulting in delayed or cancelled procedures.MethodsWe conducted telephone surveys with patients taking chronic antithrombotic medications who had recently undergone an endoscopy procedure. In the survey, we sought to better understand the peri-procedural process for patients taking antithrombotic medications. We conducted a content analysis of patients’ unstructured responses from the peri-procedural patient phone calls. We used a multi-step group coding process to analyze responses. Relationships between different themes and categories were analyzed using original quotes and retrieving thematic segments from the transcripts.ResultsThe survey was administered to 81 patients. 74/81 (91%) of respondents said they understood the plan to manage their antithrombotic, but 21/81 (26%) of respondents were not completely satisfied with the coordination, communication, and management of their medications. Five primary themes emerged from the content analysis as patient-centered design features affecting peri-procedural care: (1) patients require accurate and timely information; (2) a patient's prior experience with antithrombotic therapy affects their understanding of the process; (3) patients prefer receiving their information from a single source, and also prefer (4) different methods of instruction; (5) finally, patients expect their clinician(s) to be available through the peri-procedural management process.ConclusionTo optimize the peri-procedural medication management communication process, patients desire timeliness, accuracy, and adaptiveness to prior patient experience while offering a single, consistently available point of contact.
       
  • Physical Diagnosis of Cardiac Tamponade
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Yasuharu Tokuda
       
  • Intracardiac Metastasis as the Initial Presentation ofNon–Small Cell
           Lung Cancer
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Carmel Moazez, Emily Howard, Azar Mehdizadeh, Raina Roy, Surabhi Amar
       
  • Febrile Calcinosis in Scleroderma
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Allan C. Gelber, Michael I. Brener, Kaelin O'Connell, Michael Wu, Julie J. Paik, Jemima F. Albayda
       
  • Serotonin Syndrome Masquerading as Ventricular Tachycardia Storm
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Ramzi Dudum, M. Imran Aslam, Jose Madrazo
       
  • An Oscillating Thrombus Inside the Inferior Vena Cava
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Christos Tourmousoglou, Gerasimos Gogas, Dimitrios Siskos, Dimitrios Zioutas
       
  • Progressive Dysphonia: Ortner Syndrome
    • Abstract: Publication date: December 2018Source: The American Journal of Medicine, Volume 131, Issue 12Author(s): Matteo Coen, Igor Leuchter, Massimo Sussetto, Carlo Banfi, Raphaël Giraud, Karim Bendjelid
       
 
 
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