641. In adults with stable angina, PCI vs. a placebo procedure reduced angina symptoms at 12 wk.
Rajkumar CA, Foley MJ, Ahmed-Jushuf F, et al; ORBITA-2 Investigators. A placebo-controlled trial of percutaneous coronary intervention for stable angina. N Engl J Med. 2023;389:2319-2330. 38015442.
642. In adults with overweight or obesity and CVD, but without diabetes, semaglutide reduced MACE at a mean 40 mo.
Lincoff AM, Brown-Frandsen K, Colhoun HM, et al; SELECT Trial Investigators. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389:2221-2232. 37952131.
643. In adults aged ≥80 y with NSTE-ACS, an invasive vs. conservative strategy improved outcomes at a median 5.3 y.
Berg ES, Tegn NK, Abdelnoor M, et al; After Eighty Study Investigators. Long-term outcomes of invasive vs conservative strategies for older patients with non-ST-segment elevation acute coronary syndromes. J Am Coll Cardiol. 2023;82:2021-2030. 37968019.
644. The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline.
作者: Paula P Schnurr.;Jessica L Hamblen.;Jonathan Wolf.;Rachael Coller.;Claire Collie.;Matthew A Fuller.;Paul E Holtzheimer.;Ursula Kelly.;Ariel J Lang.;Kate McGraw.;Joshua C Morganstein.;Sonya B Norman.;Katie Papke.;Ismene Petrakis.;David Riggs.;James A Sall.;Brian Shiner.;Ilse Wiechers.;Marija S Kelber.
来源: Ann Intern Med. 2024年177卷3期363-374页
The U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) worked together to revise the 2017 VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. This article summarizes the 2023 clinical practice guideline (CPG) and its development process, focusing on assessments and treatments for which evidence was sufficient to support a recommendation for or against.
645. Meeting the Health and Social Needs of America's Unhoused and Housing-Unstable Populations: A Position Paper From the American College of Physicians.
Access to safe and stable housing has both a direct and indirect effect on health. Experiencing homelessness and housing instability can induce stress and trauma, worsening behavioral health and substance use. The absence of safe and stable living conditions can make it challenging to rest, recuperate, and recover from health ailments and can pose barriers to treatment adherence. Homelessness and housing instability is associated with high rates of numerous diseases and chronic conditions. Its cyclical relationship with other social drivers of health can exacerbate health disparities. As a result, unhoused persons experience unique health challenges and require a health care system and professionals designed to meet their distinct needs. Physicians and other health professionals have a role in educating themselves about the needs of unhoused patients as well as making themselves aware of community and government resources available to these populations. Policymakers must support health professionals in these efforts by supporting the data infrastructure needed to facilitate these referrals to resources, supporting research into best practices for caring for these populations, and investing in community-based organization capacity. Policy action is needed to address the underlying drivers of homelessness, including a dearth of affordable housing, while also addressing the short-term need for safe shelter now. In this position paper, the American College of Physicians (ACP) recognizes the need to address universal access to housing to fulfill one's right to health. ACP offers several recommendations to prevent homelessness and promote the necessary health care and social needs of unhoused populations.
646. A Risk Profile Using Simple Hematologic Parameters to Assess Benefits From Baricitinib in Patients Hospitalized With COVID-19: A Post Hoc Analysis of the Adaptive COVID-19 Treatment Trial-2.
作者: Catharine I Paules.;Jing Wang.;Kay M Tomashek.;Tyler Bonnett.;Kanal Singh.;Vincent C Marconi.;Richard T Davey.;David C Lye.;Lori E Dodd.;Otto O Yang.;Constance A Benson.;Gregory A Deye.;Sarah B Doernberg.;Noreen A Hynes.;Robert Grossberg.;Cameron R Wolfe.;Seema U Nayak.;William R Short.;Jocelyn Voell.;Gail E Potter.;Rekha R Rapaka.
来源: Ann Intern Med. 2024年177卷3期343-352页
The ACTT risk profile, which was developed from ACTT-1 (Adaptive COVID-19 Treatment Trial-1), demonstrated that hospitalized patients with COVID-19 in the high-risk quartile (characterized by low absolute lymphocyte count [ALC], high absolute neutrophil count [ANC], and low platelet count at baseline) benefited most from treatment with the antiviral remdesivir. It is unknown which patient characteristics are associated with benefit from treatment with the immunomodulator baricitinib.
647. Autoimmune Disorders Associated With Surgical Remission of Cushing's Disease : A Cohort Study.
作者: Dennis Delasi Nyanyo.;Masaaki Mikamoto.;Francesca Galbiati.;Ilan Remba-Shapiro.;Kevin Bode.;Sara Schoenfeld.;Pamela S Jones.;Brooke Swearingen.;Lisa B Nachtigall.
来源: Ann Intern Med. 2024年177卷3期315-323页
Glucocorticoids suppress inflammation. Autoimmune disease may occur after remission of Cushing's disease (CD). However, the development of autoimmune disease in this context is not well described.
648. How Would You Prevent Subsequent Strokes in This Patient? Grand Rounds Discussion From Beth Israel Deaconess Medical Center.
作者: Zahir Kanjee.;Jennifer L Dearborn-Tomazos.;Sandeep Kumar.;Eileen E Reynolds.
来源: Ann Intern Med. 2024年177卷2期238-245页
Stroke is a major cause of morbidity, mortality, and disability. The American Heart Association/American Stroke Association recently published updated guidelines on secondary stroke prevention. In these rounds, 2 vascular neurologists use the case of Mr. S, a 75-year-old man with a history of 2 strokes, to discuss and debate questions in the guideline concerning intensity of atrial fibrillation monitoring in embolic stroke of undetermined source, diagnosis and management of moderate symptomatic carotid stenosis, and therapeutic strategies for recurrent embolic stroke of undetermined source in the setting of guideline-concordant therapy.
649. Surgery, Needle Fasciotomy, or Collagenase Injection for Dupuytren Contracture : A Randomized Controlled Trial.
作者: Mikko Petteri Räisänen.;Olli V Leppänen.;Janne Soikkeli.;Aleksi Reito.;Antti Malmivaara.;Rachelle Buchbinder.;Hannu Kautiainen.;Antti Kaivorinne.;Susanna Stjernberg-Salmela.;Minna Lappalainen.;Toni Luokkala.;Annele Pönkkö.;Hanna-Stiina Taskinen.;Markus Pääkkönen.;Kati Jaatinen.;Joona Juurakko.;Venla-Linnea Karjalainen.;Teemu Karjalainen.
来源: Ann Intern Med. 2024年177卷3期280-290页
Surgery, needle fasciotomy, and collagenase injection are used to treat Dupuytren contracture. The treatment decision requires balancing initial morbidity and costs of surgery against its potential long-term benefits over needle fasciotomy and collagenase.
650. Immune-Related Adverse Events of Immune Checkpoint Inhibitors.
Immune-related adverse events (irAEs) are toxicities that arise after the administration of monoclonal antibodies targeting immune checkpoints (immune checkpoint inhibitors [ICIs]) in patients with cancer. They can occur at any time after initiation of ICI treatment, with a broad clinical phenotype that can be organ-specific or systemic. Although most irAEs manifest as mild to moderate signs and symptoms, severe forms of irAEs can lead to irreversible organ failure and have acute life-threatening presentations. Treatment should be tailored to the specific organ involved and the severity. Glucocorticoids are the first-line treatment for most irAEs, with immunosuppressants and biologics mainly used as second-line treatments.
651. Trends in Psychological Distress and Outpatient Mental Health Care of Adults During the COVID-19 Era.
作者: Mark Olfson.;Chandler McClellan.;Samuel H Zuvekas.;Melanie Wall.;Carlos Blanco.
来源: Ann Intern Med. 2024年177卷3期353-362页
In addition to the physical disease burden of the COVID-19 pandemic, concern exists over its adverse mental health effects.
652. AABB recommends restrictive RBC transfusions for hospitalized adults and children.
Carson JL, Stanworth SJ, Guyatt G, et al. Red blood cell transfusion: 2023 AABB international guidelines. JAMA. 2023;330:1892-1902. 37824153.
653. In T2DM with obesity, time-restricted eating increased weight loss and reduced HbA1c level at 6 mo.
Pavlou V, Cienfuegos S, Lin S, et al. Effect of time-restricted eating on weight loss in adults with type 2 diabetes: a randomized clinical trial. JAMA Netw Open. 2023;6:e2339337. 37889487.
654. In nursing homes, universal decolonization vs. routine care reduced transfers to hospital for infection.
Miller LG, McKinnell JA, Singh RD, et al. Decolonization in nursing homes to prevent infection and hospitalization. N Engl J Med. 2023;389:1766-1777. 37815935.
655. In acute hypoxemic respiratory failure, noninvasive oxygenation methods may reduce death vs. standard oxygen therapy.
Pitre T, Zeraatkar D, Kachkovski GV, et al. Noninvasive oxygenation strategies in adult patients with acute hypoxemic respiratory failure: a systematic review and network meta-analysis. Chest. 2023;164:913-928. 37085046.
656. In patients with OSA and CVD, CPAP did not reduce major adverse cardiac and cerebrovascular events.
Sanchez-de-la-Torre M, Gracia-Lavedan E, Benitez ID, et al. Adherence to CPAP treatment and the risk of recurrent cardiovascular events: a meta-analysis. JAMA. 2023;330:1255-1265. 37787793.
657. In persons aged ≥45 y, the mt-sRNA test had 94% sensitivity for colorectal cancer and 46% for advanced adenomas.
Barnell EK, Wurtzler EM, La Rocca J, et al. Multitarget stool RNA test for colorectal cancer screening. JAMA. 2023;330:1760-1768. 37870871.
658. In women aged 45 to 75 y, opt-out vs. opt-in breast cancer screening outreach did not increase mammography rates.
Marcotte LM, Deeds S, Wheat C, et al. Automated opt-out vs opt-in patient outreach strategies for breast cancer screening: a randomized clinical trial. JAMA Intern Med. 2023;183:1187-1194. 37695621.
659. In hypertension, with or without orthostatic hypotension, more- vs. less-intensive BP therapy improves clinical outcomes.
Juraschek SP, Hu JR, Cluett JL, et al. Orthostatic hypotension, hypertension treatment, and cardiovascular disease: an individual participant meta-analysis. JAMA. 2023;330:1459-1471. 37847274.
660. Biomarker risk assessment model identified high-risk patients with cancer who benefit from thromboprophylaxis.
Alexander M, Harris S, Underhill C, et al. Risk-directed ambulatory thromboprophylaxis in lung and gastrointestinal cancers: the TARGET-TP randomized clinical trial. JAMA Oncol. 2023;9:1536-1545. 37733336.
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