1421. After EVT for ischemic stroke, intensive vs. conventional BP management reduced functional independence at 3 mo.
Nam HS, Kim YD, Heo J, et al; OPTIMAL-BP Trial Investigators. Intensive vs conventional blood pressure lowering after endovascular thrombectomy in acute ischemic stroke: the OPTIMAL-BP randomized clinical trial. JAMA. 2023;330:832-842. 37668619.
1422. In latent autoimmune diabetes in adults, mortality was similar to T2DM but retinopathy was higher at 5.9 y.
Wei Y, Herzog K, Ahlqvist E, et al. All-cause mortality and cardiovascular and microvascular diseases in latent autoimmune diabetes in adults. Diabetes Care. 2023;46:1857-1865. 37635682.
1423. In outpatients with COVID-19 during Omicron variant circulation, molnupiravir and nirmatrelvir-ritonavir improved outcomes.
Sommer I, Ledinger D, Thaler K, et al. Outpatient treatment of confirmed COVID-19: a living, rapid evidence review for the American College of Physicians (version 2). Ann Intern Med. 2023;176:1377-1385. 37722115.
1424. CRC screening with sigmoidoscopy extends life by 110 d; other cancer screening tests do not extend life.
Bretthauer M, Wieszczy P, Løberg M, et al. Estimated lifetime gained with cancer screening tests: a meta-analysis of randomized clinical trials. JAMA Intern Med. 2023;183:1196-1203. 37639247.
1426. In noncardiac thoracic surgery, low-dose colchicine did not reduce AF or myocardial injury after noncardiac surgery at 14 d.
Conen D, Ke Wang M, Popova E, et al; COP-AF Investigators. Effect of colchicine on perioperative atrial fibrillation and myocardial injury after non-cardiac surgery in patients undergoing major thoracic surgery (COP-AF): an international randomised trial. Lancet. 2023;402:1627-1635. 37640035.
1427. Rates of Downstream Procedures and Complications Associated With Lung Cancer Screening in Routine Clinical Practice : A Retrospective Cohort Study.
作者: Katharine A Rendle.;Chelsea A Saia.;Anil Vachani.;Andrea N Burnett-Hartman.;V Paul Doria-Rose.;Sarah Beucker.;Christine Neslund-Dudas.;Caryn Oshiro.;Roger Y Kim.;Jennifer Elston-Lafata.;Stacey A Honda.;Debra Ritzwoller.;Jocelyn V Wainwright.;Nandita Mitra.;Robert T Greenlee.
来源: Ann Intern Med. 2024年177卷1期18-28页
Lung cancer screening (LCS) using low-dose computed tomography (LDCT) reduces lung cancer mortality but can lead to downstream procedures, complications, and other potential harms. Estimates of these events outside NLST (National Lung Screening Trial) have been variable and lacked evaluation by screening result, which allows more direct comparison with trials.
1428. In medical inpatients, the IMPROVE risk score had moderate predictive power for 14-d in-hospital bleeding.
Villiger R, Juillard P, Darbellay Farhoumand P, et al. Prediction of in-hospital bleeding in acutely ill medical patients: external validation of the IMPROVE bleeding risk score. Thromb Res. 2023;230:37-44. 37634309.
1429. In T2DM requiring insulin initiation, icodec titrated with an app safely reduced HbA1c vs. daily basal insulin analogues at 52 wk.
Bajaj HS, Aberle J, Davies M, et al. Once-weekly insulin icodec with dosing guide app versus once-daily basal insulin analogues in insulin-naive type 2 diabetes (ONWARDS 5): a randomized trial. Ann Intern Med. 2023;176:1476-1485. 37748181.
1430. Development and Validation of a Protein Risk Score for Mortality in Heart Failure : A Community Cohort Study.
作者: Kayode O Kuku.;Joseph J Shearer.;Maryam Hashemian.;Rebecca Oyetoro.;Hoyoung Park.;Brittany Dulek.;Suzette J Bielinski.;Nicholas B Larson.;Peter Ganz.;Daniel Levy.;Bruce M Psaty.;Jungnam Joo.;Véronique L Roger.
来源: Ann Intern Med. 2024年177卷1期39-49页
Heart failure (HF) is a complex clinical syndrome with high mortality. Current risk stratification approaches lack precision. High-throughput proteomics could improve risk prediction. Its use in clinical practice to guide the management of patients with HF depends on validation and evidence of clinical benefit.
1431. In acute decompensated HF, adding acetazolamide to IV loop diuretics reduced congestion at 3 d across eGFR levels.
Meekers E, Dauw J, Martens P, et al. Renal function and decongestion with acetazolamide in acute decompensated heart failure: the ADVOR trial. Eur Heart J. 2023;44:3672-3682. 37623428.
1438. Principles for the Physician-Led Patient-Centered Medical Home and Other Approaches to Team-Based Care: A Position Paper From the American College of Physicians.
作者: Ryan Crowley.;David Pugach.;Margo Williams.;Jason Goldman.;David Hilden.;Anne Furey Schultz.;Micah Beachy.; .; .
来源: Ann Intern Med. 2024年177卷1期65-67页
Team-based care models such as the Patient-Centered Medical Home are associated with improved patient health outcomes, better team coordination and collaboration, and increased well-being among health care professionals. Despite these attributes, hindrances to wider adoption remain. In addition, some health care professionals have sought to practice independent of the physician-led health care team, potentially undermining patient access to physicians who have the skills and training to deliver whole-person, comprehensive, and longitudinal care. In this paper, the American College of Physicians reaffirms the importance of the physician-led health care team and offers policy recommendations on professionalism, payment models, training, licensure, and research to support the expansion of dynamic clinical care teams.
1439. Ensuring Equitable Access to Participation in the Electoral Process: A Policy Brief From the American College of Physicians.
During the past 2 decades, voter turnout in U.S. presidential elections has ranged from 51.7% to 66.9% of the eligible population. Low voter turnout rates and inequitable electoral institutions, such as gerrymandered districts, can skew policy decisions toward the preferences of a smaller group and further exclude individuals and communities who have been historically marginalized and excluded from decision-making processes. Voting and health are directly connected through the institution of policies by ballot initiative and the election of officials who incorporate health into their platforms. They are also indirectly connected, as civic participation connects persons to their community and empowers them with agency in decision making. In this position paper, the American College of Physicians seeks to inform physicians, medical students, and other health care professionals on the links between electoral processes and health; encourage civic participation; and offer policy recommendations to support safe and equitable access to electoral participation to advance health equity for both patients and health care professionals.
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